Family Medicine Forum 2015 Program

PROGRAM • programme

Family Medicine Forum Forum en médecine familiale CELEBRATING FIFTEEN YEARS

CÉLÉBRONS QUINZE ANS

TORONTO NoV 11–14, 2015 RIO COL L TA

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The Ontario College of Family Physicians Le Collège des médecins de famille de l'Ontario

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Metro Toronto Convention Centre Palais des congrès du Toronto métropolitain

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fmf.cfpc.ca

welcome to fmf 2015 / bienvenue au fmf 2015

Welcome to FMF 2015 and the vibrant city of Toronto!

Connect, learn, and grow at the 15th anniversary of Family Medicine Forum! This year the Section of Researchers celebrates its 20th anniversary and launches Family Medicine Innovations in Research and Education Day in partnership with the Section of Teachers. The Sadok Besrour Global Health Conference, welcoming participants and partners from around the world, runs concurrently with FMF, and there are many other special events, functions, and awards ceremonies taking place. And don’t miss this year’s Exhibit Hall and revamped College Square!

Please review this comprehensive guide to all things FMF! You will find poster, paper, and session details; event schedules; evening celebrations—and much more. You can also download the mobile app and visit fmf.cfpc.ca to keep on top of the latest news and access the electronic version of this program.

Garey Mazowita, MD, CCFP, FCFP 2014–2015 President Président 2014–2015

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Cathy Faulds, MD, CCFP, FCFP President, OCFP Présidente, COMF

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Pierre-Paul Tellier, MD, CCFP, FCFP Chair, FMF Committee Président, Comité du FMF

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Bienvenue au FMF 2015 dans la magnifique ville de Toronto!

En ce 15e anniversaire du Forum de la médecine familiale, soyez des nôtres pour échanger, apprendre et grandir!

Cette année, la Section des chercheurs célèbre son 20e anniversaire et lance la Journée sur les innovations en recherche et en éducation en médecine familiale, en partenariat avec la Section des enseignants. La Conférence sur la santé mondiale Sadok Besrour, qui se déroule conjointement au FMF, accueillera des participants et des partenaires de partout dans le monde. Vous pourrez aussi assister à de nombreux autres événements, réceptions et cérémonies de remise de prix spéciaux. Ne manquez pas le Hall d’exposition et le nouveau Carrefour du Collège!

Jetez un coup d’œil à ce guide complet sur toutes les activités du FMF. Vous y trouverez des renseignements sur les présentations d’affiches, les présentations libres et sur toutes les séances, ainsi que l’horaire des événements et des célébrations en soirée—et bien plus. Vous pouvez également télécharger l’application mobile et visiter le fmf.cfpc.ca/fr/ pour les dernières nouvelles et obtenir la version électronique de ce programme.

Kim Bender, MD, CCFP Co-Chair, FMF 2015 Scientific Program Planning Committee Coprésidente, Sous-comité du programme scientifique du FMF 2015

Andrew Arcand, MD, CCFP(EM) Co-Chair, FMF 2015 Scientific Program Planning Committee Coprésident, Sous-comité du programme scientifique du FMF 2015

Ian Scott, MD, CCFP, FCFP Chair, Section of Teachers Président, Section des enseignants

Wendy Norman, MD, CCFP, FCFP Chair, Section of Researchers Présidente, Section des chercheurs

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FAMILY DOCTOR WEEK

MÉDECIN DE FAMILLE

November 9–14

du 9 au 14 novembre

The CFPC is proud to host Family Doctor Week in Canada as an opportunity to recognize the vital role of family physicians across Canada and the highly valued relationships they share with their patients and colleagues.

Le CMFC est fier de présenter la Semaine du médecin de famille afin de souligner le rôle vital des médecins de famille du Canada et les relations très appréciées qu’ils entretiennent avec leurs patients et leurs collègues.

This special week also provides an opportunity for governments, health care organizations, and other professionals to acknowledge the outstanding contributions made by family doctors to improve the health and well-being of their patients through their roles in clinics, hospitals, universities, and many other health care facilities in Canadian communities.

Cette semaine spéciale permet aussi aux gouvernements, aux organisations de soins de santé et aux autres professionnels de reconnaître la façon exceptionnelle dont les médecins de famille contribuent à la santé et au bien-être de leurs patients grâce au rôle qu’ils jouent dans les cliniques, les hôpitaux, les universités et les autres établissements de santé dans les collectivités canadiennes.

Follow @FamPhysCan and tweet us using the hashtag #LoveMyFamilyDoc and tell us why!

Representing excellence in Canadian family medicine, the following 10 outstanding family physicians—one from each province—are acknowledged as Canada’s Family Physicians of the Year. Each award recipient is nominated by his or her peers, colleagues, community leaders, and/or provincial Chapter for demonstrating the attributes embodied in the four principles of family medicine through their clinical practices, teaching and research, community involvement, and professional achievements. Each honoree will receive the Reg L. Perkin Award, named in honour of the former Executive Director of the CFPC (1985–1996).

Les dix médecins de famille exceptionnels suivants—un de chaque province— personnifient l’excellence en médecine familiale. Reconnu comme Médecin de famille canadien de l’année, chaque récipiendaire est nommé par ses pairs, ses collègues, les leaders de sa collectivité et sa section provinciale pour avoir incarné les quatre principes de la médecine familiale dans le cadre de ses activités cliniques, d’enseignement et de recherche, ainsi que par son implication dans sa communauté et ses réalisations professionnelles. Les récipiendaires reçoivent le Prix Reg L. Perkin, nommé en l’honneur de l’ancien directeur général du CMFC (1985–1996).

BC AB SK MB ON QC NB NS PEI NL

Anthon Meyer, MD, CCFP, FCFP Margaret Churcher, MD, CCFP, FCFP Tom Smith-Windsor, MD, CCFP, FCFP Michel Bruneau, MD, CCFP Robert Algie, MD, CCFP, FCFP Rénald Bergeron, MD, CCMF, FCMF Shirley Ann Clements, MD, CCFP, FCFP Michael Fleming, MD, CCFP, FCFP Trina Stewart, MD, CCFP, FCFP Percy Crocker, MD, CCFP, FCFP fmf.cfpc.ca

LA SEMAINE DU

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2015

Canada’s Family Physicians of the Year Les Médecins de famille canadiens de l’année Reg L. Perkin Awards Prix Reg L. Perkin

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WEDNESDAY / MERCREDI November 11 novembre

Keynote address / Discours d’ouverture

Family Medicine Innovations in Research and Education Day Journée des innovations en recherche et éducation en médecine familiale

08:30–09:30 718AB MTCC WM100

Jeffrey M. Borkan, MD, PhD

The Teaching, Research, and Practice Journey in Family Medicine: Getting your story “right”

Le parcours de l’enseignement, de la recherche et de la pratique en médecine familiale : bien connaître « votre » récit

Learning Objectives:

Objectifs d’apprentissage :

1. Elucidate your own personal and professional narrative.

1. Élucider votre récit narratif personnel et professionnel.

2. Reflect on your roles as teacher, researcher, and clinician.

2. Réfléchir sur vos rôles en tant qu’enseignant, chercheur et clinicien.

3. Consider the use of narrative as a tool for teaching, research, and practice.

3. Considérer l’utilisation du récit narratif comme un outil pour l’enseignement, la recherche et la pratique.

FMF keynotes are M1 accredited. Remember to claim your credits.

Les séances plénières du FMF donnent droit à des credits M1. N’oubliez pas de demander vos credits.

“These pioneers have demonstrated the value of research that is informed by doctorpatient relationships, continuity of care, community and population connections, and commitment to teaching the very attributes that family doctors bring to Canadians on a daily basis.”

TOP 20

PIONEERS OF FAMILY MEDICINE RESEARCH IN CANADA

« Ces pionniers ont démontré la valeur de la recherche fondée sur les relations médecin-patient, la continuité des soins, le lien entre la communauté et la population et l’engagement envers l’enseignement, soit justement les attributs que les médecins de famille mettent au service des Canadiens et Canadiennes tous les jours ».

—Garey Mazowita, MD, CCFP, FCFP, President

“I commend the Section of Researchers for their dedicated work to advocate for family medicine research since 1995. Collectively, they have created a community of practice in family medicine that has inspired health professionals to work together, learn from one another, and make positive advancements to the discipline of family medicine and family practice.”

SECTION OF RESEARCHERS • SECTION DES CHERCHEURS

« Je félicite la Section des chercheurs pour leur travail exemplaire depuis 1995, dans le but de promouvoir la recherche en médecine familiale. Collectivement, ils ont créé une communauté de pratique en médecine familiale qui a inspiré les professionnels de la santé à collaborer et à apprendre les uns des autres, afin de faire progresser la —Francine Lemire, MD CM, CCFP, FCFP, CAE, Executive Director and CEO discipline et la pratique de médecine familiale ». fmf.cfpc.ca

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Schedule of events / programme

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WEDNESDAY / MERCREDI November 11 novembre Schedule of events / PROGRAMME

07:00–19:00

Registration open / Ouverture des inscriptions 600 Foyer MTCC

07:30–08:15

Breakfast / Petit déjeuner 700 Foyer MTCC

08:15–09:45

Keynote / Discours d’ouverture 718AB MTCC

09:45–12:00

Posters and workshops / Affiches et ateliers 700 Level MTCC

12:00–13:00

Section of Researchers Lunch / Dîner de la Section des chercheurs 718AB MTCC

12:00–13:00

Section of Teachers Lunch / Dîner de la Section des enseignants 701AB MTCC

13:15–15:00

Posters, presentations, and workshops / Affiches, présentations et ateliers 700 Level MTCC

15:00–17:00 Free-standing papers, workshops, and reflections of the day Présentations libres, ateliers et réflexion sur la journée 700 Level MTCC 18:30

Buses depart MTCC – South Building Départ des autobus du PCTM – Édifice Sud

19:00–21:30 Section of Researchers Dinner / Souper de la Section des chercheurs

The SoR and SoT invite you to their annual celebratory dinners.

Les Sections des chercheurs et des enseignants vous invitent à leur souper commémoratif annuel.

WEDNESDAY / MERCREDI November 11 novembre Section of Researchers Dinner / Souper de la Section des chercheurs Location / Endroit : Liberty Grand, Centennial Room Ticket price / Prix du billet : $120 Includes / Comprend : Welcome reception, gourmet dinner, wine, soft drinks, shuttle bus to and from the venue / Réception d’accueil, repas gourmet, vin, boissons gazeuses, allerretour du PCTM (navette) The Section of Researchers will proudly present the Family Medicine Researcher of the Year award along with several other prestigious awards of recognition.

La Section des chercheurs remettra le prix du Chercheur en médecine familiale de l’année ainsi que plusieurs autres prix de reconnaissance prestigieux.

Section of Teachers Dinner will be held Friday, November 13th. See Friday’s schedule for details.

Le souper de la Section des enseignants aura lieu le vendredi 13 novembre.

Voir le programme de vendredi pour de plus amples renseignements.

Breakfast, breaks, and lunch are included with your registration fees. / Vos frais d’inscription comprennent le petit déjeuner, les pauses-santé et le repas du midi.

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THURSDAY / JEUDI November 12 novembre

Keynote address / Discours d’ouverture

08:00–09:30 Hall F/G MTCC TJ200 In Study Lies Our Strength: Family Physicians in the 21st Century Learning Objectives:

Sister / Sœur Elizabeth M. Davis, BA, BEd, MA, MHSc, LLD

1. Appreciate the significant implications of the deceptively simple CFPC motto (In Study Lies Our Strength) for the practice of family medicine in Canada in light of the intense social, political, technological, and environmental changes of this time in our history.

2. Understand what “study” means for family physicians today as the understanding of health and health care is being transformed in these changing times.

3. See in a new way the kinds of “strength” that family physicians, individually and collectively, must bring to the citizens of Canada who give family medicine its privileged professional status.

TJ200 L’étude est notre force : le médecin de famille au XXIe siècle Objectifs d’apprentissage : 1. Prendre conscience des implications importantes de la devise du CMFC (L’étude est notre force), qui n’est pas aussi simple qu’elle n’y paraît, pour la pratique de la médecine familiale au Canada, compte tenu de l’envergure des changements sociaux, politiques, technologiques et environnementaux de notre époque.

2. Comprendre ce que veut dire « étude » pour les médecins de famille d’aujourd’hui, à une époque où la compréhension de la santé et des soins de santé fait l’objet d’une transformation.

FMF keynotes are M1 accredited.

Remember to claim your credits.

Les séances plénières du FMF donnent droit à des credits M1. N’oubliez pas de demander vos credits.

3. Voir sous un autre angle les types de « force » que les médecins de famille, individuellement et collectivement, doivent apporter à la population canadienne, apport qui donne à la médecine familiale son statut professionnel privilégié.

Medical Student Scholarships

Bourses d’études pour les étudiants en médecine

One outstanding student from each medical school in Canada will receive a scholarship supported by CFPC’s Research and Education Foundation and Scotiabank.

Be there to recognize and celebrate the future of family medicine.

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Un étudiant exceptionnel de chaque faculté de médecine au pays recevra une bourse d’études. Ces bourses bénéficient de l’appui de la Fondation pour la recherche et l’éducation du CMFC et de la Banque Scotia. Venez célébrer l’avenir de la médecine familiale.

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THURSDAY / JEUDI November 12 novembre Schedule of events / PROGRAMME

Schedule of events / programme 06:30–17:30 Registration open / Ouverture des inscriptions 600 Foyer MTCC 07:00–17:00 Exhibit Hall open / Ouverture du hall d’exposition Hall E MTCC 08:00–18:30 Scientific Program schedule / Horaire du programme scientifique

07:00–08:00 Breakfast / Networking Breakfasts Petit déjeuner / Petits déjeuners de réseautage Hall E & 700 Level MTCC 08:00–09:30 Opening Ceremonies and Keynote Address: CFPC / Scotiabank Family Medicine Lectureship Cérémonies et discours d’ouverture : Prix de la Conférence en médecine familiale CMFC / Banque Scotia Medical Student Scholarship Presentations / Bourses d’études pour les étudiants en médecine Hall F/G MTCC 12:15–13:45 Lunch / Dîner Hall E MTCC 12:15–13:45 CFPC Annual Meeting of Members / Assemblée annuelle des membres du CMFC 718AB MTCC 12:30–13:30 TICKETS REQUIRED / BILLETS REQUIS First Five Years in Family Practice Luncheon Dîner des médecins de famille dans les cinq premières années de pratique Location / Endroit : SoCo Ballroom, Delta Toronto Hotel 17:30–18:30 FMF Welcome Reception / Réception d’accueil au FMF 700 Foyer MTCC 18:00–19:00 OCFP Annual Meeting of Members Assemblée annuelle des membres du CMFO Location / Endroit : SoCo Ballroom, Delta Toronto Hotel 19:00–21:00 OCFP President’s Installation and Awards Ceremony Installation de la présidente du CMFO et Cérémonie de remise des prix Location / Endroit : SoCo Ballroom, Delta Toronto Hotel 19:00–22:30 TICKETS REQUIRED / BILLETS REQUIS Student and Resident Social Evening Soirée sociale des étudiants et des résidents Ticket price / Prix du billet : $65 Location / Endroit : SPiN Toronto 18:30 Buses depart MTCC South Building / Navette de l’édifice Sud du PCTM

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FRIDAY / vendredi November 13 novembre

Keynote address / Discours d’ouverture

08:00–08:40 Hall F/G MTCC

FV300 Choosing Wisely Canada / Choisir avec soin Canada

Wendy Levinson, MD Chair, Choosing Wisely Canada Présidente, Choisir avec soin Canada

Lynn Wilson, MD Primary Care Co-lead, Choosing Wisely Canada Coresponsable des soins primaires, Choisir avec soin Canada

Dr Wendy Levinson is a professor of medicine at the University of Toronto and a national and international expert in the field of physician-patient communication and on the disclosure of medical errors to patients.

Dr Lynn Wilson is a professor and chair of the Department of Family and Community Medicine at the University of Toronto and practises family medicine at Women’s College Hospital.

Dre Wendy Levinson est professeure de médecine à l’Université de Toronto et experte nationale et internationale dans le domaine de la communication médecin-patient et de la divulgation des erreurs médicales aux patients.

Dre Lynn Wilson est professeure et directrice du Département de médecine familiale et communautaire à l’Université de Toronto, et elle exerce la médecine familiale à l’hôpital Women’s College.

CONNECT / ÉCHANGER “I love being part of such a large community of doctors. The venue was excellent and the talks I attended were very interesting.” « Je suis très contente de faire partie d’une si grande communauté de médecins. Le site était excellent et les présentations auxquelles j’ai assisté étaient très intéressantes. »

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Choosing Wisely Canada (CWC) is a campaign to help physicians and patients discuss tests, treatments, and procedures, and make smart and effective choices to ensure high-quality care. It is modeled after the Choosing Wisely® campaign in the United States, launched by the ABIM (American Board of Internal Medicine) Foundation in April 2012. Choosing Wisely Canada launched in Ontario and has quickly been adopted by all provincial and territorial medical associations. It is now a truly national campaign in Canada and leads the international effort.

FV300 Choosing Wisely Canada Learning Objectives: 1. To describe the reasons that physicians may order tests that don’t add value or may harm patients 2. To describe the Choosing Wisely Canada campaign and the role of primary care 3. To share specific strategies to implement Choosing Wisely in medical education and practice

FV300 Choisir avec soin Canada Objectifs d’apprentissage : 1. Décrire les raisons que les médecins évoquent pour demander des tests qui n’ajoutent pas de valeur ou qui peuvent causer un préjudice aux patients.

2. Décrire la campagne Choisir avec soin Canada et le rôle des soins primaires.

3. Partager des stratégies précises afin de mettre en œuvre Choisir avec soin dans la formation médicale et la pratique.

FMF keynotes are M1 accredited. Remember to claim your credits.

Les séances plénières du FMF donnent droit à des credits M1.

N’oubliez pas de demander vos credits.

This campaign has created patient-friendly educational materials and is working with various groups to disseminate these materials widely.

CWC is also working with medical schools to introduce new content into the undergraduate, postgraduate, and continuing medical education curricula.

Choisir avec soin est une campagne visant à aider médecins et patients à discuter des examens, traitements et interventions dans le but de faire des choix judicieux et efficaces afin d’assurer des soins de grande qualité. Cette campagne s’inspire de l’initiative américaine Choosing Wisely® lancée par la Fondation de l’American Board of Internal Medicine (ABIM) en avril 2012. Choisir avec soin a d’abord été lancée en Ontario et a rapidement été adoptée par les associations médicales de l’ensemble des provinces et territoires. Il s’agit maintenant d’une campagne à l’échelle du pays qui se trouve à l’avant-plan de l’effort international.

Dans le cadre de la campagne, du matériel de formation convivial a été créé pour les patients, et divers groupes de travail s’affairent à diffuser ce matériel à grande échelle. Choisir avec soin travaille également avec les facultés de médecine pour intégrer du nouveau contenu au cursus des programmes d’études prédoctorales, postdoctorales et de formation médicale continue.

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friDAY / vendreDI November 13 novembre Schedule of events / PROGRAMME

Schedule of events / programme Prevention

in hand www.preventioninhand.com

06:30–17:30

Prévention

en main

Registration open / Ouverture des inscriptions 600 Foyer MTCC

07:00–16:00 Exhibit Hall open / Ouverture du hall d’exposition

Hall E MTCC

www.preventionenmain.com

The College of Family Physicians of Canada (CFPC) in partnership with the Public Health Agency of Canada (PHAC) has been collaborating on the development of the Prevention in Hand (PiH) initiative, a one-stop, user-friendly website and mobile application that will be a valuable health care resource with current and clinically reviewed information about the prevention of chronic diseases. Join Dr Francine Lemire, CEO of CFPC on Friday, November 13th at 9:40 am for an informal presentation of the PiH website in College Square in the Exhibit Hall.

Le Collège des médecins de famille du Canada (CMFC), en partenariat avec l’Agence de la santé publique du Canada (ASPC), a développé l’initiative Prévention en main (PeM), un site Web convivial complet et une application mobile qui serviront de ressource importante en santé contenant de l’information à jour et révisée cliniquement en matière de prévention des maladies chroniques. Joignez-vous à Dre Francine Lemire, chef de la direction, le vendredi 13 novembre à 9 h 40, pour un lancement informel du site web PeM qui aura lieu dans le Hall d’exposition du Carrefour du Collège.

08:00–18:30

Scientific Program schedule Horaire du programme scientifique

07:00–08:00 Breakfast / Networking Breakfasts Petit déjeuner / Petits déjeuners de réseautage Hall E & 700 Foyer MTCC 08:00–09:30 Keynote Address / Discours d’ouverture President’s Installation / Installation de la présidente Hall F/G MTCC 12:15–13:45

Lunch / Dîner Hall E MTCC

12:30–13:30 Section of Teachers Annual Meeting Assemblée annuelle de la Section des enseignants 718AB MTCC 18:30–22:00 TICKETS REQUIRED / BILLETS REQUIS Section of Teachers Dinner Souper de la Section des enseignants Location / Endroit : SoCo Ballroom, Delta Toronto Hotel Ticket price / Prix du billet : $120 Walking distance from MTCC Distance de marche du PCTM

LEARN / APPRENDRE “FMF is all about meeting friends and getting up to date on the most current information and guidelines related to family medicine.” « Le FMF est l’occasion de rencontrer des amis et de se mettre à niveau sur les dernières nouvelles et lignes directrices liées à la médecine familiale. » fmf.cfpc.ca

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08:45–09:00 Hall F/G MTCC State of the College address ALLOCUTION sur la situation du Collège Garey Mazowita, MD, CCFP, FCFP 2014–2015 President / Président 2014–2015 The College of Family Physicians of Canada Le Collège des médecins de famille du Canada CFPC President Dr Garey Mazowita received his medical degree from the University of Manitoba in 1979. Currently, he is a clinical professor with the Faculty of Medicine at the University of British Columbia and teaches, conducts research, and operates a clinical practice in Vancouver. Throughout his career, he has been actively involved with the CFPC. Dr Mazowita will deliver the State of the College Address highlighting goals and accomplishments of the past year.

Le Dr Garey Mazowita a obtenu son diplôme en médecine de l’Université du Manitoba en 1979. Il est professeur clinique au département de médecine de famille à la faculté de médecine de l’Université de la Colombie-Britannique. Il pratique de façon active et continue d’enseigner et de faire de la recherche à Vancouver. Dr Mazowita a participé activement aux activités du CMFC tout au long de sa carrière. Il prononcera l’allocution sur la situation du Collège en soulignant les objectifs et les réalisations de la dernière année.

09:00–09:30 Hall F/G MTCC CFPC president’s installation installation de la présidentE du cmfc Jennifer Hall, MD, CCFP, FCFP 2015–2016 President / Présidente 2015–2016 The College of Family Physicians of Canada Le Collège des médecins de famille du Canada Dr Jennifer Hall received her medical degree from Memorial University in Newfoundland in 1992. Dr Hall is currently Associate Professor of Family Medicine at Dalhousie University in Halifax and the Dalhousie Family Medicine Residency Program Director. She is also a preceptor to undergraduate medical students and residents from both Dalhousie and Memorial universities. Since 1996, Dr Hall has held many diverse roles with the College, as an examiner and a member of several committees. She served on the Board of the New Brunswick Chapter for five years, representing continuing professional development (CPD) interests.

Dre Jennifer Hall a obtenu son diplôme en médecine de l’Université Memorial de Terre-Neuve en 1992. À l’heure actuelle, elle est professeure agrégée en médecine familiale à l’Université Dalhousie, à Halifax, et dirige le programme de résidence en médecine familiale de cet établissement. Elle supervise des étudiants en médecine de niveau prédoctoral ainsi que des résidents des universités Dalhousie et Memorial. Dre Hall a occupé plusieurs fonctions au Collège depuis 1996.

Elle a été examinatrice et membre de plusieurs comités et a siégé au conseil d’administration de la section provinciale du Nouveau-Brunswick pendant cinq ans en tant que représentante du développement professionnel continu. = Simultaneous Interpretation / Interprétation simultanée fmf.cfpc.ca

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saturDAY / samedi November 14 novembre Schedule of events / PROGRAMME

Schedule of events / programme 06:30–15:30

Registration open / Ouverture des inscriptions 600 Foyer MTCC

07:00–13:45 Exhibit Hall open / Ouverture du hall d’exposition

Hall E MTCC 08:30–16:00

Scientific Program schedule / Horaire du programme scientifique

07:00–08:00

Breakfast / Networking Breakfasts Petit déjeuner / Petits déjeuners de réseautage Hall E & 700 Foyer MTCC

07:00–08:00 CFPC Walk for the Docs of Tomorrow Marche du CMFC pour les médecins de demain Meet at the MTCC: near Registration on Level 600 Rencontre au PCTM : près des inscriptions au niveau 600 12:15–13:45

Lunch / Dîner Hall E MTCC

12:30–13:30 TICKETS REQUIRED / BILLETS REQUIS Medical Student and Family Medicine Resident Networking Luncheon Dîner de réseautage des étudiants et des résidents en médecine familiale Location / Endroit : SoCo Ballroom, Delta Toronto Hotel 17:00–18:30 Convocation / Collation des grades Hall F MTCC 18:30–20:30 FMF Celebration – All are welcome! / Célébration du FMF – Tous sont les bienvenus!

Hall G MTCC

GROW / GRANDIR “I really enjoy the topics presented—it’s nice to have medical education as well as topics on teaching and research … all in the same place and time.” « J’ai beaucoup aimé les sujets présentés.

C’est extraordinaire d’avoir de l’éducation médicale de même que des présentations sur l’enseignement et la recherche en même temps et sous un même toit. » fmf.cfpc.ca

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YOU ARE INVITED!

CFPC Convocation Ceremony Metro Toronto Convention Centre, South Building, Level 800 Saturday, November 14, 2015

VOUS ÊTES INVITÉS !

Cérémonie de collation des grades du CMFC Palais des congrès du Toronto métropolitain, Édifice Sud, niveau 800 Samedi 14 novembre 2015

EVENT

time/heure

place/endroit level 800/niveau 800

activitÉ

Gown pickup and photography

Friday/Vendredi 08:00–17:00 & Saturday/Samedi 08:00–14:00

Hall D

Cueillette de la toge et photographie

Doors open for Convocation guests

Saturday/Samedi 16:00

Hall F

Portes ouvertes pour les invités

Convocant check-in

Saturday/Samedi 16:00

Hall D

Arrivée

Marshaling

Saturday/Samedi 16:15

Hall D

Défilé

Convocation Ceremony

Saturday/Samedi 17:00–18:30

Hall F

Cérémonie de collation des grades

Gown and hood return

Saturday/Samedi 18:30–20:30

Hall D

Retour de la toge et de l’épitoge

FMF Celebration

Saturday/Samedi 18:30–20:30

Hall G

Célébration du FMF

fmf.cfpc.ca

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12 3

9 FMF DAILY SCHEDULE HORAIRE QUOTIDIEN DU FMF

6

FMF DAILY SCHEDULE

HORAIRE QUOTIDIEN DU FMF

Wednesday

Mercredi

07:00–19:00 Registration open Exhibit Hall closed

07:00–19:00 Heures d’ouverture des inscriptions Hall d’exposition fermé

08:15–17:00 Family Medicine Innovations in Research and Education Day

08:15–17:00 Journée des innovations en recherche et education en médecine familiale

Thursday

Jeudi

06:30–17:30 Registration open

06:30–17:30 Heures d’ouverture des inscriptions

07:00–17:00 Exhibit Hall open

07:00–17:00 Heures d’ouverture du hall d’exposition

07:00–08:00 Networking sessions

07:00–08:00 Séances de réseautage

08:00–09:30 Opening Ceremonies and Keynote Address

08:00–09:30 Cérémonies et discours d’ouverture

09:30–10:00 Break and poster viewing

09:30–10:00 Pause et visite des affiches

10:00–12:15 Sessions

10:00–12:15 Séances

12:15–13:45 Lunch

12:15–13:45 Dîner

13:45–14:45 Sessions

13:45–14:45 Séances

14:45–15:15 Break

14:45–15:15 Pause

15:15–17:30 Sessions

15:15–17:30 Séances

Friday

Vendredi

06:30–17:30 Registration open

06:30–17:30 Heures d’ouverture des inscriptions

07:00–16:00 Exhibit Hall open

07:00–16:00 Heures d’ouverture du hall d’exposition

07:00–08:00 Networking sessions

07:00–08:00 Séances de réseautage

08:00–09:30 Keynote Address and CFPC President’s Installation

08:00–09:30 Discours d’ouverture et Cérémonie de l’installation du président du cmfc

09:30–10:00 Break and poster viewing

09:30–10:00 Pause et visite des affiches

10:00–12:15 Sessions

10:00–12:15 Séances

12:15–13:45 Lunch

12:15–13:45 Dîner

13:45–14:45 Sessions

13:45–14:45 Séances

14:45–15:15 Break

14:45–15:15 Pause

15:15–17:30 Sessions

15:15–17:30 Séances

Saturday

Samedi

06:30–15:30 Registration open

06:30–15:30 Heures d’ouverture des inscriptions

07:00–13:45 Exhibit Hall open

07:00–13:30 Heures d’ouverture du hall d’exposition

07:00–08:00 Walk for the Docs of Tomorrow

07:00–08:00 Marche pour les médecins de demain

08:30–10:45 Sessions

08:30–10:45 Séances

10:45–11:15 Break and Exhibit Hall Contest Prize Draw

10:45–11:15 Pause et tirage du concours du hall d’exposition

11:15–12:15 Sessions

11:15–12:15 Séances

12:15–13:45 Lunch

12:15–13:45 Dîner

13:45–16:00 Sessions

13:45–16:00 Séances fmf.cfpc.ca

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IMPORTANT INFORMATION

INFORMATIONS IMPORTANTES

REGISTRATION: Metro Toronto Convention Centre, South Building, 600 level Please pick up your name badge (if you have not received it by mail), lanyard, and delegate bag, and have your name badge scanned.

INSCRIPTION : Palais des congrès du Toronto métropolitain, immeuble Sud, niveau 600 Veuillez aller chercher votre insigne d’identité (si vous ne l’avez pas reçue par la poste), votre cordon et votre trousse du participant, et faire scanner votre insigne d’identité.

SPEAKERS: Please pick up your badge at Registration and proceed to the Speakers’ Room (Room 809) at least one hour prior to your session.

EXHIBITORS: All exhibit personnel must check in at the Exhibitor Registration Desk, 600 level, before proceeding to the Exhibit Hall, located on the 800 level of the Metro Toronto Convention Centre, South Building.

NAME BADGES: Your registration badge must be worn at all times and entitles you to attend keynotes, scientific sessions, exhibits, breakfasts, breaks, lunches (tickets required), the President’s Installation, Convocation, and the FMF Celebration. Badges for paid accompanying persons will entitle them to attend keynotes, some sessions, exhibits, breakfasts, breaks, lunches (tickets required), the President’s Installation, Convocation, and the FMF Celebration.

DAILY BADGE SCAN REQUIRED: Remember to have your name badge scanned EVERY DAY at registration and at various entrances of the Metro Toronto Convention Centre. Self-scanning stations are also available throughout the conference venues. All scanned registrants will receive a letter confirming their attendance at Family Medicine Forum by January 1, 2016. Please note that these letters are not available for on-site pickup.

BAR CODE READERS IN THE EXHIBIT HALL: Many exhibitors will have bar code readers at their booths.

With your permission, booth staff will scan the bar code on your badge to obtain the information as it appears on your FMF 2015 registration, including name, address, phone number, and email address.

CONFÉRENCIERS : Veuillez aller chercher votre insigne d’identité au Bureau des inscriptions et vous rendre à la salle des conférenciers (salle 809) au moins une heure avant votre séance.

EXPOSANTS : Tous les membres du personnel des exposants doivent s’inscrire au Bureau des inscriptions des exposants, au niveau 600, avant de se rendre au Hall d’exposition, situé au niveau 800 du Palais des congrès du Toronto métropolitain, immeuble Sud. INSIGNES D’IDENTITÉ : Vous devez porter votre insigne d’identité en tout temps, car elle vous donne le droit d’assister aux plénières, aux séances scientifiques, aux expositions, aux petits déjeuners, aux pauses-santé, aux dîners (billets requis), à la cérémonie d’installation de la présidente, à la collation des grades et à la célébration du FMF. Les insignes d’identité des personnes qui vous accompagnent leur donnent le droit d’assister aux plénières, à certaines séances, aux expositions, aux petits déjeuners, aux pauses-santé aux dîners (billets requis), à la cérémonie d’installation de la présidente, à la collation des grades et à la célébration du FMF. SCANNAGE QUOTIDIEN : N’oubliez pas de faire scanner votre insigne d’identité TOUS LES JOURS, au Bureau d’inscription ou aux différentes entrées du Palais des congrès du Toronto métropolitain.

Des postes de lecteurs sont également situés à des endroits pratiques un peu partout sur les lieux de la conférence.

Toutes les personnes inscrites qui ont fait scanner leur insigne d’identité recevront une lettre confirmant leur participation au Forum en médecine familiale d’ici le 1er janvier 2016.

Veuillez noter que ces lettres ne seront pas disponibles sur place.

LECTEUR DE CODE À BARRES DANS LE HALL D’EXPOSITION : De nombreux exposants disposeront d’un lecteur de code à barres dans leur kiosque. Avec votre permission, le préposé des kiosques scannera votre insigne d’identité pour obtenir l’information telle qu’elle apparaît dans votre inscription au FMF 2015, soit vos nom, adresse, numéro de téléphone et adresse courriel.

fmf.cfpc.ca

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Family Medicine Forum 2015 | Forum en médecine familiale 2015

17

MAINPRO®–M1 credits

Crédits MAINPRO®–M1

This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited for up to 26.0 Mainpro-M1 credits.

Ce programme satisfait aux critères d’agrément du Collège des médecins de famille du Canada et donne droit à jusqu’à 26,0 crédits Mainpro-M1.

Wednesday, Nov 11th maximum 6.0 credits based on individual sessions attended

Mercredi 11 novembre vous pouvez réclamer jusqu’à 6,0 crédits

Thursday, Nov 12th maximum 7.0 credits based on individual sessions attended Friday, Nov 13th maximum 7.0 credits based on individual sessions attended Saturday, Nov 14th maximum 6.0 credits based on individual sessions attended Credits can only be claimed for the individual sessions that have been accredited by the CFPC. Please consult your records to verify which sessions you attended on each day.

Report your credits using ONE of the following methods: • download the FMF mobile app or • log in to your account on the CFPC website at www.cfpc.ca/login/ If you have already submitted your credits by using the CFPC Mobile App or the Mainpro Credit Reporting Form online, you do not need to enter them again.

Important Information: • Additional credits may be claimed for participation in Ancillary Sessions indicated in this program (Session #s T111504 A; T118642 A; F111302 A; F115446 A; F114793 A; and S114835 A).

• Certificates of attendance for Mainpro-C workshops will be provided separately by the individual course provider.

Mainpro Lounge • Visit the Mainpro Lounge to meet CPD Regional Educators and other CPD management staff.

• Learn about and provide your feedback on: o Upcoming launch of Mainpro+ in 2016 o New Mainpro+ credit categories o FAQs related to Mainpro+ Starting in 2016, the way you report credits is changing!

As part of the CFPC’s ongoing commitment to providing quality continuing professional development (CPD), the MAINPRO® program is being enhanced to meet your changing interests and learning requirements. Some exciting changes will be taking place in 2016 with the launch of our new system, Mainpro+®.

Mainpro+ will be easier and more intuitive to use with a new online reporting tool to make reporting credits easy and efficient. New activity categories of Self-Learning, Group Learning, and Assessment will replace M1, M2, and MC, and credit categories will soon be known as Certified and Non-Certified. For more information, or to ask questions, please come visit CPD staff in the Mainpro Lounge!

Questions about FMF 2015?

Contact fmfinfo@cfpc.ca

Questions about Mainpro credit reporting?

Visit www.cfpc.ca/MAINPRO/ or contact mainprocredits@cfpc.ca

18

vous pouvez réclamer jusqu’à 7,0 crédits

Vendredi 13 novembre vous pouvez réclamer jusqu’à 7,0 crédits Samedi 14 novembre vous pouvez réclamer jusqu’à 6,0 crédits Vous pouvez obtenir des crédits pour les séances individuelles agréées par le CMFC seulement. Veuillez consulter vos dossiers pour voir les séances auxquelles vous avez assisté chaque jour.

Déclarer vos crédits en utilisant l’UNE des méthodes suivantes : • Téléchargez l’appli mobile du FMF ou • Ouvrez votre compte par l’intermédiaire du site Web du CMFC (www.cfpc.ca/ouverturedesession/) Si vous avez soumis vos crédits à l’aide de l’appli du CMFC ou en utilisant le formulaire de déclaration de crédits Mainpro sur le site Web, vous n’avez pas à les entrer une deuxième fois.

Renseignements importants : • Vous pouvez obtenir des crédits additionnels en assistant aux séances auxiliaires qui figurent dans le programme (Numéros de séances T111504 A; T118642 A; F111302 A; F115446 A; F114793 A; et S114835 A).

• Les attestations de participation aux ateliers Mainpro-C seront fournies séparément par le fournisseur du cours.

SALON MAINPRO • Visitez le SALON MAINPRO pour rencontrer les Éducateurs régionaux pour le DPC et les membres de la direction du département de DPC. • Renseignez-vous et donnez-nous vos commentaires sur : o le lancement de Mainpro+ en 2016 o les nouvelles catégories de crédits Mainpro+ o la FAQ sur Mainpro+ Nouvelle façon de soumettre vos crédits en 2016!

Dans le cadre de son engagement à fournir des programmes de développement professionnel continu (DPC) de qualité, le CMFC améliore le programme MAINPRO® afin de répondre à vos besoins et aux exigences d’apprentissage. Nous apporterons des changements intéressants en 2016 avec le lancement de notre nouvelle plateforme Mainpro+®.

Mainpro+ sera plus convivial et plus intuitif grâce à un nouvel outil efficace pour la déclaration électronique de crédits. Les nouvelles catégories d’activités d’autoapprentissage, d’apprentissage en groupe et d’évaluation remplaceront les catégories M1, M2 et MC. Les catégories de crédits seront appelées certifiée et non certifiée. Pour de plus amples renseignements, veuillez vous adresser au personnel du DPC dans le salon Mainpro+.

Pour de plus amples renseignements au FMF 2015 fmfinfo@cfpc.ca Pour de plus amples renseignements sur l’appli du CMFC – cfpcmobileapp@cfpc.ca

Questions about the CFPC App? Contact cfpcmobileapp@cfpc.ca

fmf.cfpc.ca

Jeudi 12 novembre

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Family Medicine Forum 2015 | Forum en médecine familiale 2015

Pour de plus amples renseignements sur la déclaration de crédits Mainpro – www.cfpc.ca/MAINPRO/ ou mainprocredits@cfpc.ca

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2015 Honours and Awards Recipients Presenting the Showcase of Honorees – We invite you to visit our display at the REF / Honours and Awards Booth at College Square in the Exhibit Hall and at the registration area.

Family Medicine Honour Roll – We are pleased to present a brand new website, designed to both recognize and celebrate the outstanding accomplishments of family physicians, family medicine residents, medical students, and other members of the CFPC. Visit http://fmhonourroll.cfpc.ca and celebrate excellence in family medicine with us!

New Awards for 2015 and their Recipients For more information on the full Honours and Awards catalogue, please visit www.cfpc.ca/awards

The Jim Ruderman Academic Family Medicine Leadership Award Dr James Ruderman (Posthumously), Toronto, ON Power of the Arts in Family Medicine Fellowship Dr Stephen J. Darcy on behalf of Shea Heights Community Alliance, St John's, NL

Patient’s Medical Home 60/20 Caring and Compassion Grant Dr Tracy Burton, Pincher Creek, AB Ms Joyce Lo on behalf of North York Family Health Team: Poverty Screening Pilot Project, Toronto, ON Dr Nicholas Potvin on behalf of Palliative Care Resource Team, Peace River, AB Hollister King Rural Family Practice CPD Grant Dr Adrian Edgar, Marysville, NB

Récipiendaires des prix et bourses pour 2015 Présentation sur nos récipiendaires : Nous vous invitons à visualiser notre présentation au kiosque de la FRÉ/Prix et bourses dans le Carrefour du Collège situé dans le Hall d’exposition et près du comptoir d’inscription.

Livre d’or de la médecine familiale : Nous sommes heureux de présenter un tout nouveau site Web qui souligne les réalisations exceptionnelles des médecins de famille, résidents en médecine familiale, étudiants en médecine et autres membres du Collège. Visitez le http://fmhonourroll.cfpc.ca/fr/ et célébrez l’excellence en médecine familiale avec nous.

Récipiendaires de nouveaux prix et bourses pour 2015

Pour de plus amples renseignements et pour consulter la liste complète des Prix et bourses, visitez le http://www.cfpc.ca/ prixetbourses

Le Prix Jim Ruderman pour le leadership en médecine familiale universitaire Dr James Ruderman (à titre posthume), Toronto (Ontario) Fellowship sur le pouvoir des arts en médecine familiale Dr Stephen J. Darcy au nom du Shea Heights Community Alliance, St John’s (Terre-Neuve-et-Labrador)

La Subvention 60/20 pour la compassion du Centre de médecine de famille Dre Tracy Burton, Pincher Creek (Alberta) Mme Joyce Lo au nom du North York Family Health Team: Poverty Screening Pilot Project, Toronto (Ontario) Dr Nicholas Potvin au nom du Palliative Care Resource Team, Peace River (Alberta) La Subvention de DPC Hollister King pour la pratique familiale rurale Dr Adrian Edgar, Marysville (Nouveau-Brunswick)

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2014–2015 CFPC EXECUTIVE COMMITTEE COMITÉ DE DIRECTION DU CMFC EN 2014–2015 President / Président Garey Mazowita, MD, CCFP, FCFP, Vancouver, BC Past-President / Présidente sortante Kathy Lawrence, MD, CCFP, FCFP, Regina, SK

British Columbia / Colombie-Britannique Christie Newton, MD, CCFP, FCFP, Port Moody, BC Patricia Mirwaldt, MD, CCFP, Vancouver, BC Alberta Patricia Smith, MD, CCFP, Calgary, AB

President-Elect / Présidente désignée Jennifer Hall, MD, CCFP, FCFP, Rothesay, NB

Saskatchewan Paula Schwann, MD, CCFP, FCFP, Saskatoon, SK Danielle Cutts, MD, CCFP, Regina, SK

Honorary Secretary-Treasurer Secrétaire trésorièr honoraire David White, MD, CCFP(EM), FCFP, Toronto, ON

Manitoba Susan Fair, MD, CCFP, FCFP, Winnipeg, MB

Member-at-Large / Représentant des membres Guillaume Charbonneau, MD, CCMF, Messines, QC Member-at-Large / Représentante des membres Claudette Chase, MD, CCFP, FCFP, Shuniah, ON

EXECUTIVE TEAM Équipe de direction Executive Director and Chief Executive Officer Directrice générale et Chef de la direction Francine Lemire Executive Director, Academic Family Medicine Directrice générale, Médecine familiale universitaire Pamela Eisener-Parsche Executive Director, Professional Development and Practice Support Directeur général, Développement professionnel continu Jamie Meuser Executive Director, Corporate Services Directrice générale, Affaires générales Theresa Maguire-Garber Executive Director, Member and External Relations Directeur général, Services aux membres et relations externes Eric J. Mang Executive Director, Information and Technology Services Directeur général, Serv. des technologies de l’information Rabin Samaroo

fmf.cfpc.ca

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CFPC BOARD OF DIRECTORS CONSEIL D’ADMINISTRATION DU CMFC

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Family Medicine Forum 2015 | Forum en médecine familiale 2015

Ontario Jonathan Kerr, MD, CCFP, Belleville, ON Cathy Faulds, MD, CCFP, FCFP, London, ON Quebec Dominique Deschênes, MD, CCMF, Quebec, QC Maxine Dumas-Pilon, MD, CCMF, Montreal, QC Caroline Laberge, MD, CCMF, Quebec, QC New Brunswick / Nouveau-Brunswick Marc-Andre Doucet, MD, CCMF, Bathurst, NB Nova Scotia / Nouvelle-Écosse Susan Malloy, MD, CCFP, Hammonds Plains, NS Prince Edward Island / Île-du-Prince-Édouard Lana Barkhouse, MD, CCFP, Charlottetown, PE Shannon Curtis, MD, CCFP, Charlottetown, PE Newfoundland & Labrador / Terre-Neuve-et-Labrador Jackie Elliott, MD, CCFP, Paradise, NL Section of Residents / Section des résidents Alexis Lemmex, MD, London, ON Steve Hawrylyshyn, MD, CCFP, Toronto, ON Jaspreet Mangat, MD, Edmonton, AB Section of Medical Students Section des étudiants en médecine Sara Porisky, Calgary, AB Wilfred Chan, Aurora, ON Marie Giroux, Sherbrooke, QC National Association of Chairs of Family Medicine Association nationale des directeurs Canadiens de médecine familiale Marie Giroux, MD, CCMF, FCMF, Sherbrooke, QC Public Members / Représentant du public Scott Dudgeon, Toronto, ON Bill Mussell, Chilliwack, BC Linda Ross, St John's, NL

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2014–2015 OCFP EXECUTIVE DIRECTION DU CMFO EN 2014–2015

OCFP BOARD OF DIRECTORS CONSEIL D’ADMINISTRATION DU CMFO

President / Présidente Cathy Faulds, MD, CCFP, FCFP, London, ON

John Brewer, MD, CCFP, FCFP, Ottawa, ON Amy Catania, MD, CCFP, Orangeville, ON Jane Charters, MD, MCFP, Oakville, ON Peter Hutten-Czapski, MD, CCFP, FCFP, Haileybury, ON Art Kushner, MD, MCFP, Etobicoke, ON Terry Mccarthy, Hamilton, ON Jennifer Young, MD, CCFP(EM), Collingwood, ON

Past President / Président sortant Jonathan Kerr, MD, CCFP, Belleville, ON President-Elect / Présidente designée Sarah-Lynn Newbery, MD, CCFP, Marathon, ON Secretary-Treasurer / Secrétaire-trésorier Glenn Brown, MD, CCFP(EM), FCFP, Napanee, ON

SCIENTIFIC PROGRAM SUB-COMMITTEE SOUS-COMITÉ DU PROGRAMME SCIENTIFIQUE

FAMILY MEDICINE FORUM COMMITTEE COMITÉ DU FORUM EN MÉDECINE FAMILIALE

Co-chairs / Coprésidents Kim Bender, MD, CCFP, Smithville, ON Andrew Arcand, MD, CCFP(EM), Markham, ON Pierre-Paul Tellier, MD, CCFP, FCFP, Montreal, QC

Chair / Président Pierre-Paul Tellier, MD, CCFP, FCFP, Montreal, QC

France Boudreau, MD, CCFP, Dip. Sport Med., Ottawa, ON Judith Belle Brown, MCFP(Hon), London, ON Reena Dhatt, MD, CCFP, FCFP, Sudbury, ON Stephane Foidart, MD, CCFP, Kenora, ON Heather Galbraith, MD, Sudbury, ON Janice Harvey, MC, CCFP, FCFP, Ancaster, ON Lucy Horvat, MD, MSc, CCFP, Acton, ON Frank Martino, MD, CCFP(EM), FCFP, Brampton, ON Kendall Noel, MEd, MDCM, CCFP, FCFP, Ottawa, ON Jordana Sheps, MD, CCFP, Toronto, ON Rebecca Stoller, MD, CCFP, North York, ON Lori Teeple, MD, CCFP(EM), FCFP, Strathroy, ON Vu Kiet Tran, MD, CCFP(EM), FCFP, Richmond Hill, ON Erica Weinberg, MD, MCFP, Toronto, ON

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Members / Membres Natalie Cauchon, MD, CCMF, Bathurst, NB Alexandra Chesley, Edmonton, AB Scott Garrison, MD, CCFP, Edmonton, AB Cathy MacLean, MD, CCFP, FCFP, St John’s, NL Scott MacLean, MD, CCFP, Edmonton, AB Ainslie Mihalchuk, MD, CCFP, Winnipeg, MB Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON Anne-Patricia Prévost, MD, CCMF, Longueil, QC Stephanie Roman, MD, CCFP, Kingston, ON

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Save the

date Scientific

OCFP 54th ANNUAL

Assembly

nov 24-26, 2016

November 24 – 26, 2016 Fairmont Royal York Hotel Toronto, Ontario

www.ocfp.on.ca

CANADIAN FAMILY PHYSICIAN

July Juillet 2015;61:569-648

July • Juillet 2015

CFP is Canada’s only peer-reviewed family medicine journal, with full text of all articles permanently archived in PubMed Central alongside all of the world’s leading medical journals. CFP is always looking for potential authors, particularly for clinical reviews and case reports. Stop by College Square and meet Dr Nick Pimlott, Scientific Editor, and Dr Roger Ladouceur, Associate Scientific Editor, for advice on writing and submitting manuscripts for publication.

Canadian Family Physician

Dr Caitlin Harmon Victoria, BC ...623

Le Médecin de famille canadien

Editorial

Golden age of family medicine research Nicholas Pimlott If I have ever made any valuable discoveries, it has been owing more to patient attention, than to any other talent.

GloBal HealtH editorial . . . 576 Commentary . . . 578, 582, 584 Clinical Review . . . 596 Motherisk Update . . . 607 Program Description . . . 614 Research . . . e303, e310

santÉ MonDiale Éditorial . . . 577 Commentaire . . . 587, e293, e295 Révision clinique . . . 597 Mises à jour de Motherisk . . . e299 Description de programme . . . 615 Recherche . . . e331, e338

Peer reviewed | Révisée par des pairs • PubMed | PubMed Central | www.cfp.ca

Isaac Newton

T

his month marks the 20th anniversary of the Section of Researchers (SOR) of the College of Family Physicians of Canada and an opportunity for real celebration.

During these 20 years the family medicine research enterprise in Canada has grown enormously and arguably is now coming of age. Before the 1990s family medicine research was mainly a cottage industry, with a handful of professional researchers and a small, but still substantial, minority of family physicians carrying out research “around the kitchen table.”1 With the creation of the first research career-track programs in the larger academic family medicine departments, family medicine has been able to establish a national and internationally recognized group of professional researchers able to compete at the highest levels for research grants and publication in prestigious peer-reviewed journals.2-4 The SOR has been instrumental in this success.

Although they might not realize it, all family physicians engage with and contribute to research on many levels, even if they are not professional researchers themselves. A fundamental way that family physicians engage with research is as consumers of its products— the results of randomized controlled clinical trials of therapies and screening tests, the appropriate use of new and more accurate diagnostic tests, and the implementation of recommendations from clinical practice guidelines, to name but a few.

For busy family physicians, maintaining the skills of acute clinical observation in combination with the ability to write and publish case reports is one of the most meaningful ways to engage in research and contribute to the “database” of family medicine. This remains an important part of the research continuum in family medicine and one of the most accessible ways that the average family physician can contribute to research in our discipline.5 The most useful and practical case reports published in this journal have been those contributed by family physicians.6 The growth of the quality improvement movement has provided opportunities for all family physicians to engage in a microcosmic research experience. Although research might be defined as the generation of generalizable knowledge, the process of studying one’s own practice and behaviour with a view to improving the

Cet article se trouve aussi en français à la page 490.

References 1. Falk WA. The curious family doctor. Research by family doctors in Canada in the early years. Bloomington, IN: Trafford Publishing; 2001.

2. Hogg W, Donskov M, Russell G, Pottie K, Liddy C, Johnston S, et al. Riding the wave of primary care research. Development of a primary health care research centre. Can Fam Physician 2009;55:e35-40. Available from: www.cfp. ca/content/55/10/e35.full.pdf+html. Accessed 2015 May 7.

3. Talbot YR, Rosser WW. Taking the first steps. Research career program in family medicine. Can Fam Physician 2001;47:1254-60.

4. Rosser W, Godwin M, Seguin R. Family medicine research capacity building. Five-weekend programs in Ontario. Can Fam Physician 2010;56:e94-100.

Available from: www.cfp.ca/content/56/3/e94.full.pdf+html. Accessed 2015 May 7.

5. Pimlott N. Two cheers for case reports. Can Fam Physician 2014;60:966 (Eng), 967 (Fr).

6. Majerovich JA, Canty A, Miedema B. Chronic vulvar irritation: could toilet paper be the culprit? Can Fam Physician 2010;56:350-2.

7. Allan GM, Kraut R, Crawshay A, Korownyk C, Vandermeer B, Kolber MR. Contributors to primary care guidelines. What are their professions and how many of them have conflicts of interest? Can Fam Physician 2015;61:52-8 (Eng), e50-7 (Fr).

8. Birtwhistle RV. Canadian Primary Care Sentinel Surveillance Network. A developing resource for family medicine and public health. Can Fam Physician 2011;57:1219-20 (Eng), e401-2 (Fr).

9. Garies S, Irving A, Williamson T, Drummond N. Using EMR data to evaluate a physician-developed lifestyle plan for obese patients in primary care. Can Fam Physician 2015;61:e225-31.

Vol 61: june • juin 2015

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Le MÉDICINE DE FAMILLE CANADIEN

MD CCFP, SCIENTIFIC EDITOR

end product follows a very similar process and is crucial to improving patient care.

There are many problems with current models of clinical practice guideline development and implementation,7 but they represent a tremendous opportunity for greater family physician engagement and influence on both research and knowledge translation.

Although Canada has been slow off the mark compared with other countries, one of the most exciting recent developments in family medicine research has been practice-based research networks, the largest of which is the Canadian Primary Care Sentinel Surveillance Network. 8 Practice-based research networks will provide unprecedented opportunities for family physicians who make important new clinical observations and who are practising as part of larger practice-based research networks to leverage the expertise of both their research colleagues and the collective clinical data available through the networks. Using evolving information technology to create virtual observatories where clinical observations can be shared and approaches to patient management compared is truly an innovation whose time has come.9 These are exciting times in family medicine research in Canada. If the past 20 years have seen a coming of age of research, surely the years ahead have the potential to be a golden age in which all family physicians—from the community-based family physician to the professional researcher—are fully engaged in the research enterprise of family medicine. The SOR will undoubtedly continue to play a crucial role as we usher this golden age in.

| Canadian Family Physician

•

Le Médecin de famille canadien

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Le MFC est la seule revue en médecine familiale révisée par des pairs dont le texte intégral des articles est archivé en permanence dans PubMed Central, aux côtés des articles des revues médicales les plus réputées au monde. Le MFC est toujours à la recherche d’auteurs potentiels, en particulier de révisions cliniques et de rapports de cas. Arretez-vous au Carrefour du MFC et rencontrez nos rédacteurs – Dr Nick Pimlott, rédacteur scientifique, et Dr Roger Ladouceur, rédacteur scientifique adjoint – pour des conseils sur la rédaction et la soumission d’articles pour publication. @familymedforum

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Medical Students, Family Medicine Residents, and Family Physicians in their First Five Years of Practice

Les étudiants en médecine, résidents en médecine familiale, et médecins de famille dans leurs cinq premières années de pratique

Medical students, family medicine residents, and family physicians in their first five years of practice are welcome to attend all sessions at FMF.

Les étudiants en médecine, résidents en médecine familiale et médecins de famille dans leurs cinq premières années de pratique sont les bienvenus à toutes les séances du FMF.

In addition, we have many sessions that were specifically designed with the learning needs of these groups in mind.

En outre, nous offrons un grand nombre de séances conçues spécialement pour répondre aux besoins en matière de formation de ces groupes.

In order to highlight these presentations, we have included the following symbols in the program, identifying specific sessions as those that may be of particular interest.

Afin de permettre aux participants de repérer facilement ces séances, nous avons ajouté les symboles suivants dans le programme.

HIGHLIGHTS / POINTS SAILLANTS THURSDAY / JEUDI 11:15–12:15

First Five Years in Family Practice: Using social media and online technology safely in your practice 716B MTCC

12:30–13:30 First Five Years in Family Practice Luncheon Dîner des médecins de famille dans les cinq premières années de pratique SoCo Ballroom, Delta Toronto Hotel 13:45–14:45 First Five Years in Family Practice: Improving efficiency and time management in your early career 716B MTCC 15:15–16:15 Back to the Future: The family physicians of today meet the family doctors of tomorrow 803B MTCC 19:00–22:30

Student Resident Social Evening. See page 9 for more information. Tickets required.

FRIDAY / VENDREDI 13:45–14:45 Becoming a Resident: It’s not as bad as you think!

709 MTCC

SATURDAY / SAMEDI 07:00–08:00

Walk for the Docs of Tomorrow / Marche pour les médecins de demain

08:30–09:30 Prison Health Educational Opportunities for Medical Students and Residents 715B MTCC 11:15–12:15 Making a Smooth Transition Into Practice 705 MTCC 12:30–13:30 Medical Student and Family Medicine Resident Networking Luncheon Dîner de réseautage des étudiants et des résidents en médecine familiale SoCo Ballroom, Delta Toronto Hotel 13:45–16:00 Role of Resident Representative on Accreditation Visits Rosedale Room, Delta Toronto Hotel

fmf.cfpc.ca

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Meetings / Réunions Wednesday, November 11th / Mercredi 11 novembre Family Medicine National Education Administrators (FMNEA) Meeting.................................................................... 08:15–17:00 711 MTCC Section of Researchers Chair’s Report ..................................... 12:30–13:00 718AB MTCC Rapport de la présidente de la Section des chercheurs Accreditation Committee Meeting........................................... 15:30–17:00 703 MTCC

Thursday, November 12th / Jeudi 12 novembre First Five Years in Family Practice Committee Meeting............. 08:00–11:30 704 MTCC Canadian National Behavioural Medicine Meeting.................. 10:00–12:15 Humber – Intercontinental Hotel Enhanced Skills Program Directors Meeting............................. 10:00–17:30 Parkdale A/B – Delta Toronto Hotel Canadian Undergraduate Family Medicine.............................. 10:00–17:30 Harbourfront – Delta Toronto Hotel Education Directors (CUFMED) Meeting CFPC Annual Meeting of Members . .................................... 12:15–13:45 718AB MTCC Assemblée annuelle des membres du CMFC OCFP Annual Meeting of Members......................................... 18:00–19:00 SoCo Ballroom – Delta Toronto Hotel

Friday, November 13th / Vendredi 13 novembre Emergency Medicine Program Directors Meeting.................... 10:00–13:30 Parkdale AB – Delta Toronto Hotel Academic Coordinators Meeting............................................. 10:00–12:15 Harbourfront – Delta Toronto Hotel Health Professionals Educators Network (HPEN) Meeting........ 12:15–17:30 Kensington A – Delta Toronto Hotel Section of Teachers Annual Meeting ................................... 12:30–13:30 718AB MTCC Assemblée annuelle de la Section des enseignants In-training Evaluation Directors Meeting.................................. 13:45–17:30 Kensington B – Delta Toronto Hotel

Saturday, November 14th / Samedi 14 novembre Family Medicine Chairs Meeting............................................. 08:00–14:45 Parkdale AB – Delta Toronto Hotel EBM Teachers Meeting............................................................. 08:30–10:45 Humber – Intercontinental Hotel Family Medicine Program Directors Meeting........................... 08:30–16:00 Kensington A – Delta Toronto Hotel National Section of Medical Students (SOMS) Family.............. 10:00–16:00 Kensington B – Delta Toronto Hotel Medicine Interest Group (FMIG) Meeting Faculty Development Interest Group Meeting.......................... 13:45–16:00 Harbourfront – Delta Toronto Hotel

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée fmf.cfpc.ca

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mainpro-c sessions / sÉances mainpro-C Pre-registERED DELEGATES ONLY / DÉLÉguÉs préinscrits seulement Wednesday / Mercredi W99547 MC 08:00–10:00

IUD Insertions and Endometrial Biopsies (Beginners) 202B MTCC

W102859 MC Dermatology Procedural Skills Workshop 08:00–12:30 203A MTCC W96133 MC 08:00–16:00

Spirometry in Family Practice

W95065 MC 08:00–16:30

Optometry Workshop: The basics

201D MTCC

202A MTCC

W101299 MC Collaborating to Manage Constipation in Long-Term/Palliative Care 08:00–16:00 201B MTCC W101121 MC Cognitive Behaviour Therapy on-the-Fly 08:00–16:30 201E MTCC W101633 MC Pain and Addictions Primer for Family Physicians 08:00–17:00 201A MTCC WT99988 MC Emergency Medicine Review (CAEP) 08:00–19:00 205AB MTCC W101126 MC Healthy Child Development: Fetal alcohol spectrum disorder and substance use in pregnancy 08:30–12:00 201C MTCC W99987 MC 10:30–12:30

Difficult IUD Insertions and Endometrial Biopsies (Advanced) 202B MTCC

W102445 MC PAACT: Anemia – 2015 Update 13:30–16:00 203B MTCC

Thursday / jeudi T99946 MC 08:00–19:00

CASTED: Emergency – The hands-on ED orthopedics course (1) 206CD MTCC

T100242 MC Airway Intervention and Management in Emergencies (Course 1) 08:00–19:00 206AB MTCC T95014 MC 08:30–12:00

ECG Workshop: The basics 203B MTCC

T101106 MC Don't Just Do Something – Stand There! Best practices in reducing 10:00–17:00 unnecessary tests, treatments, and care (1)

203A MTCC T101300 MC Conducting Family Meetings for Patients With Delirium in Long-Term/Palliative Care 10:00–17:30 201C MTCC

LEGEND / LÉGENDE MC = Mainpro-C

D = Demonstration theatre / Théâtre de démonstration fmf.cfpc.ca

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mainpro-c sessions / sÉances mainpro-C Pre-registERED DELEGATES ONLY / DÉLÉguÉs préinscrits seulement T101805 MC Managing Chronic Non-Cancer Pain: Assessment, treatment, and responsible prescribing 10:00–17:30 201B MTCC T95028 MC 14:00–17:30

ECG Workshop: Advanced 203B MTCC

T101133 MC Insomnia: Beyond the basics 14:00–17:30 201D MTCC T102469 MC Best Practices for ADHD Across the Lifespan 14:00–17:30 201A MTCC T102906 MC This Patient Drives Me Crazy! Understanding the doctor-patient relationship using Balint groups 14:00–17:30 202B MTCC

Friday / vendredi F101620 MC 08:00–12:30

Leadership Development Program: Informal leadership – Oh dear, what can the matter be?

F101639 MC 08:00–12:30

Healthy Child Development: Preventive care visits for children and adolescents

F102422 MC 08:00–12:30

PAACT: Men’s health update 2015

F101094 MC 08:00–17:00

Emergency Department Procedures Made Easy!

F99903 MC 08:00–19:00

CASTED: Emergency – The hands-on ED orthopedics course (2)

F101005 MC 08:00–19:00

CASTED: Primary care – The hands-on orthopedics course for family physicians (1)

F108488 MC 08:00–19:00

Airway Intervention and Management in Emergencies (Course 2)

201B MTCC

202D MTCC

203B MTCC

202A MTCC

206CD MTCC

206EF MTCC

206AB MTCC

FS101138 MC Learning Essential Approaches to Palliative and End-of-Life Care (LEAP) – 2-day course 08:30–16:00 203C MTCC F101124 MC 10:00–17:00

Don't Just Do Something—Stand There! Best practices in reducing unnecessary tests, treatments, and care (2) 203A MTCC

F101302 MC 10:00–17:30

Ethical Decision Making and Dyspnea in Long-Term/Palliative Care

F101926 MC 10:00–17:30

Lots of Practical Pearls for Managing Asthma and COPD in Family Medicine

F102498 MC 10:00–17:30

Scholarship and Innovation in Medical Education (SIME)

F101134 MC 14:00–17:30

Leadership Development Program: Informal leadership – Being a change champion is hard work

F101622 MC 14:00–17:30

Managing Uncertainty: A novel approach to undifferentiated mental disorders

201C MTCC

202B MTCC

201D MTCC

201B MTCC

201A MTCC

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mainpro-c sessions / sÉances mainpro-C Pre-registERED DELEGATES ONLY / DÉLÉguÉs préinscrits seulement F101638 MC 14:00–17:30

Women's Hands-On Gynecological Procedures: Benign uterine conditions

F101636 MC 14:00–18:00

Treating Poverty: An approach to office-based poverty interventions and income replacement programs for family physicians

F102447 MC 14:00–18:00

PAACT Anti-infective – 2015 update

202C MTCC

202D MTCC

203B MTCC

Saturday / samedi S95069 MC 08:00–12:00

Decision-Making Capacity Assessment

S99296 MC 08:00–16:30

Medical Record Keeping

S101007 MC 08:00–18:30

CASTED: Fracture clinic – The hands-on follow-up orthopedics course

202A MTCC

201F MTCC

206CD MTCC

S99935 MC CASTED: Primary care – The hands-on orthopedics course for family physicians (2) 08:00–19:00 206EF MTCC S101108 MC 08:00–12:00

Behavioural and Psychological Symptoms of Dementia (BPSD): Applying the P.I.E.C.E.S. framework for effective clinical management of BPSD

201D MTCC

S101303 MC 08:00–16:00

Addressing Fatigue and End-of-Life Discussions With Long-Term/Palliative Care Patients

S101629 MC 08:00–16:30

Joint Assessment Made Easy

S102436 MC 08:00–12:00

PAACT Respiratory (COPD/Asthma) – 2015 update

201A MTCC

202C MTCC

203B MTCC

S99574 MC Social CBT: High-impact tools for improving social satisfaction 08:30–12:00 205AB MTCC S100963 MC 08:30–12:00

Environment-Linked Illnesses: Chronic pain, fatigue, and chemical intolerance linked to environment exposures; office assessment and management

201B MTCC

S101123 MC 08:30–12:00

Practical Office Management of Comorbid Alcohol and Anxiety Disorders

S99575 MC 13:30–17:00

Enhancing Personal Effectiveness: Leveraging CBT tools to live a more successful life

201E MTCC

205AB MTCC

LEGEND / LÉGENDE MC = Mainpro-C

D = Demonstration theatre / Théâtre de démonstration fmf.cfpc.ca

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demonstration theatre / thÉÂTRE DE DÉMONSTRATION Pre-registRATION REQUIRED / PRÉINSCRIPTION OBLIGATOIRE Pre-registered delegates only please / Délégués préinscrits seulement EXHIBIT HALL / hall D’EXPOSITION MTCC

Thursday / jeudi T101436 D 10:00–11:00

Practical Wound Care for the Family Physician

T102326 D 11:15–12:15

Left to Your Devices (1)

T120658 D 13:45–14:45

Left to Your Devices (2)

T102383 D 15:15–16:15

Musculoskeletal Ultrasound in Sports Medicine (1)

T102405 D 16:30–17:30

Musculoskeletal Ultrasound in Sports Medicine (2)

Friday / vendredi F99993 D 10:00–11:00

IUD Insertions: Beginners

F99885 D 11:15–12:15

Difficult IUD Insertions: Advanced (1)

F100122 D 13:45–14:45

Difficult IUD Insertions: Advanced (2)

F115123 D 15:15–16:15

Difficult IUD Insertions: Advanced (3)

Saturday / samedi S98933 D 09:45–10:45

Dermoscopy 101 for the Family Physician (1)

S102356 D 11:15–12:15

Dermoscopy 101 for the Family Physician (2)

LEGEND / LÉGENDE MC = Mainpro-C

D = Demonstration theatre / Théâtre de démonstration fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Breakfast / Petit déjeuner

08:15–08:30

Welcome / Bienvenue

718AB MTCC

718AB MTCC

WM100 Keynote / plénière 08:30–09:30 The Teaching, Research, and Practice Journey in Family Medicine: Getting your story “right” Le parcours de l‘enseignement, de la recherche et de la pratique en médecine familiale : bien connaître « votre » récit

Jeffrey M. Borkan, MD, Pawtucket, RI 718AB MTCC

Learning objectives: 1. elucidate your own personal and professional narrative 2. reflect on your roles as teacher, researcher, and clinician 3. consider the use of narrative as a tool for teaching, research, and practice

WEDNESDAY • MERCREDI

07:30–08:15

Description: Dr Jeffrey M. Borkan, MD, PhD, is a family physician educator, researcher, clinician, and advocate whose career has bridged two fields, family medicine and medical anthropology, both in the US and abroad. Dr Borkan is an engaging speaker who is sure to challenge and stimulate us to reflect upon the various roles played by family physicians. Dr Borkan joined the Department of Family Medicine at Brown University, Alpert Medical School, as a research professor and chair in 2001. His research interests include medical education, health policy, cultural sensitivity, and primary care, using qualitative and mixed methods techniques.

He has been active in Rhode Island and national health care policy, including chairing the Rhode Island Primary Care Physician Advisory Board, serving as president and chair of the Association of Departments of Family Medicine, and the Council of Academic Family Medicine (the national UScoordinating body for all academic family medicine). He is also an assistant dean for Primary Care – Population Medicine at Brown.

Objectifs d‘apprentissage : 1. élucider votre récit narratif personnel et professionnel 2. réfléchir sur vos rôles en tant qu‘enseignant, chercheur et clinicien 3. considérer l‘utilisation du récit narratif comme un outil pour l‘enseignement, la recherche et la pratique Description : Dr Jeffrey M. Borkan, MD, PhD est un enseignant, chercheur, clinicien en médecine familiale et défenseur de la discipline. Sa carrière a touché à deux domaines : la médecine familiale et l‘anthropologie médicale, tant aux États-Unis qu‘à l‘étranger. Dr Borkan est un conférencier captivant qui saura nous interpeller et stimuler notre réflexion sur les divers rôles que jouent les médecins de famille. Depuis 2001, Dr Borkan travaille au département de médecine de famille de la Faculté de médecine Alpert de l‘université Brown en tant que professeur-chercheur et directeur du département. Ses intérêts pour la recherche portent sur l‘éducation médicale, les politiques en matière de santé, la sensibilité culturelle et les soins primaires à l‘aide de techniques qualitatives et de méthodes mixtes. Il a été actif au Rhode Island et à l‘échelle nationale en ce qui concerne les politiques sur les soins de santé, a été président du Rhode Island Primary Care Physician Advisory Board, de l‘Association of Departments of Family Medicine et du Council of Academic Family Medicine (l‘organisme national qui coordonne la médecine familiale universitaire). Il est également vice-doyen en Soins primaires-Médecine de la population à l‘Université Brown.

09:45–11:00 Poster Viewing / Visite des affiches

716AB MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE W96565 10:30–12:00

Governing Our Postgraduate Medical Education System: How can we do it better?

Carol Herbert, MD, CCFP, FCFP, FCAHS, Vancouver, BC; Nick Busing, MD, CCFP, FCFP, Ottawa, ON 714B MTCC

Learning objectives: 1. explain the concept of complex adaptive systems in PGME 2. define collaborative governance and consensus-driven decision making 3. identify contentious issues that could be brought to the PGME Governing Council Description: Decision making within postgraduate medical education (PGME) is a complex and complicated process, not only in Canada but also in the United States, Australia, and the United Kingdom. There are many stakeholders with legitimate interests, including educators, certifying bodies, regulators, governments, and learners. The Future of Medical Education PG (FMEC-PG) project recognized the complexity of the Canadian PGME environment and explicitly made a recommendation to develop a collaborative governance structure to achieve efficiency, reduce redundancy, and provide clarity on strategic directions and decisions in order to prepare socially accountable physicians to produce high-quality health care for Canadians. This session will begin with a description of the process used by the FMEC-PG Governance Implementation Committee to consider various models of collaborative governance for PGME and to choose a principle-based model for consensus-based decision making that involves a memorandum of understanding (MOU) among participating organizations with appropriate terms of reference (ToR). Next, the session will describe the challenges in creating ToR that respect the need for autonomy and distinct objectives of participating organizations while recognizing that compromises will be required to achieve joint goals. The proposed Canadian PGME Governing Council (GC) will be described. This session will then engage participants in an analysis of issues that could reasonably be brought to the GC to generate consensus-based recommendations. Participants will be challenged to create a hierarchy of issues that need a collaborative solution, outlining the risks and benefits of making a given decision.

W115053 Teaching and Assessing the Collaborator Role: An interactive workshop with a national focus 10:30–12:00 Deborah Kopansky-Giles, BPHE, DC, FCCS, MSc, Toronto, ON; Christie Newton, MD, CCFP, FCFP, Vancouver, BC; Alison Eyre, MD, CM, CCFP, Ottawa, ON; Steve Balkou, MSc, Sherbrooke, QC; Tanya Magee, BN, RN, Halifax, NS 714A MTCC Learning objectives: 1. discuss the current frameworks that guide the development of competency in the realm of the Collaborator Role 2. discover at least one tool or strategy to integrate into teaching and promoting the Collaborator Role 3. describe examples of how to assess the competencies in the Collaborator Role within the participant‘s setting Description: How do we teach and assess the Collaborator Role in family medicine? Are we doing it well enough? How can we improve? Do we need more tools? Collaboration is an essential competency for a family doctor. It is also an accreditation standard that family medicine programs teach and assess as the Collaborator Role. However, identifying and assessing this role‘s competencies through residency training remains challenging. The Collaborator Role Working Group at the College of Family Physicians of Canada has been tackling these questions over the past two years. Working Group members have reviewed the relevant frameworks, provided input into the CanMEDS 2015 and CanMEDS-FM rewrites, and developed a set of best practices to teach and assess the acquisition of competency in this role. Providing best practice tools and strategies will not only facilitate these processes in family practice teaching but also help to ensure comparability of programming across the country so that all family medicine residents in Canada are supported in the attainment of these Collaborator Role competencies. This session will be of interest to teachers, program directors, health professional educators, and curriculum/assessment leads. After a brief didactic presentation we will work in small break-out groups (both French and English) to apply the information provided to develop approaches that can be used to teach and assess the Collaborator Role within the participants‘ own environments.

W100411 11:00–12:00

Using Nominal Group Technique for Triple C Competency-based Curriculum Development Eric Wong, MD, CCFP, MClSc(FM), London, ON; Jamie Wickett, MD, CCFP, London, ON 717B MTCC

Learning objectives: 1. describe how to use nominal group technique (NGT) to achieve consensus 2. describe how NGT can assist Triple C Competency-based Curriculum transformation through the development of educational objectives and assessment criteria, and the provision of faculty development opportunities Description: The NGT is a structured, group-consensus-building technique that has been shown to generate a greater quantity of unique ideas and participant satisfaction than traditional interacting groups (Van de Ven and Delbecq, 1974). In our experience, NGT is very effective in generating consensus around educational objectives and assessment criteria. At Western University, we have been using NGT to build consensus on Entrustable Professional Activities that will guide our Triple C Competency-based Curriculum in terms of curricular development and assessment. Additionally, NGT generates great opportunities for faculty development. This interactive workshop will engage participants in a live NGT session to build consensus around a topic of participants‘ choice. Examples of how NGT can assist in Triple C Competencybased Curriculum transformation will be shared.

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Julie Copeland, MD, CCFP, Mount Brydges, ON 715A MTCC Learning objectives: 1. understand and use the One-Minute Preceptor model and SNAPPs with learners 2. provide effective feedback to learners 3. understand how to teach procedures Description: Family physicians are frequently involved in teaching medical students and residents. Having an understanding of some core teaching concepts and techniques is essential. In addition, finding time to teach in a busy practice can be very challenging, and using efficient and effective teaching techniques is critical. This workshop will help enhance new teachers‘ effectiveness by reviewing key topics in education including giving feedback, the One-Minute Preceptor model, and teaching procedures. The workshop learning objectives will be met using a variety of techniques including interactive discussions with participants, review of audio video vignettes, role-play scenarios, and PowerPoint presentation.

WEDNESDAY • MERCREDI

W101592 Want to Teach? An interactive workshop for new teachers in family medicine 11:00–12:00 Jamie Wickett, MD, CCFP, London, ON; Daniel Grushka, MD, CCFP (EM), London, ON;

W102913 Questions in Practice (QUIPs): Teaching residents to use clinically relevant EBM skills 11:00–12:00 Norah Duggan, MD, CCFP, St. John‘s, NL; Susan Avery, MD, CCFP, St John‘s, NL; Lisa Bishop, PharmD, St John‘s, NL; Stephen Darcy, MD, CCFP, FCFP, Mount Pearl, NL 715B MTCC Learning objectives: 1. describe an effective method of teaching learners to find evidence-based answers to daily clinical questions 2. lead a group of learners through a clinically relevant EBM (QUIPs) session 3. write a field note providing effective feedback on EBM skills to a learner Description: Questions in practice (QUIPs) sessions are designed to aid family medicine residents to acquire and apply evidence-based medicine (EBM) research and analysis skills relevant to daily practice. Residents are taught to identify questions during their clinical experience, to perform a literature search using the highest level of evidence available, and to critically appraise the ”one best paper” they identify. They must also be able to identify any change to practice they would make based on the evidence. In this workshop, participants will be taught to lead a resident or group of residents through a literature search using various databases (DynaMed, Cochrane, etc.) to find the best available publication to answer their clinical question. The steps in analyzing the literature will be reviewed, with teaching tips for participants to use in helping their learners understand each step in the process. Steps for providing a useful field note with constructive feedback to help a learner further develop their EBM skills will also be taught.

W102838 11:00–12:00

Assessment in Competency-Based Medical Education: Finding assessment strategies that fit your program S helley Ross, PhD, Edmonton, AB; Shirley Schipper, MD, CCFP, Edmonton, AB; Paul Humphries, MD, CCFP, FCFP, Edmonton, AB; Michel Donoff, MD, CCFP, FCFP, Edmonton, AB 717A MTCC

Learning objectives: 1. discuss basic assessment theory, particularly as it applies to competency-based assessment 2. describe how workable, competency-based assessment can be done 3. identify at least one assessment strategy or tool for use in participant‘s own program Description: As medical education moves globally toward a competency-based approach, programs need good strategies to track learners‘ progress toward competency. Multiple frameworks for competency-based medical education (CBME) exist; deciding upon strategies, instruments, or approaches (entrustable professional activities? progress testing? milestones? formative feedback?) is a daunting task. Trying to determine the whys and hows of assessment has been a barrier to CBME implementation. This primarily interactive workshop is for anyone with questions about how to implement workable competency-based assessment, and for those who are already carrying out competency-based assessment and would like to share experiences—positive and negative—with others. In the first half of the workshop, there will be a summary overview of assessment theory in the context of practical application in CBME, with a bibliography provided for those who wish to explore theories more deeply. Participants will next be introduced to a sampling of approaches and tools for CBME assessment, along with examples and bibliographies. In the second half of the workshop, participants will apply what they have learned in themed small groups (each group based on one aspect its members have selected to assess from their own programs), discussing the possible tools they could use to assess their selected program example.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Presentation by the Recipient of the CFPC Outstanding Family Medicine Research Article Présentation par le récipiendaire du Prix du CMFC pour un article exceptionnel de recherche en médecine familiale W121589 Effect of Payment Incentives on Cancer Screening in Ontario Primary Care 11:00–11:15 Tara Kiran, MD, MSc, Toronto, ON; Andrew S, Wilton, MSc; Rahim Moineddim, PhD; Lawrence Paszar, MD, MSc; Richard Glazier, MD, MPH, CCFP, FCFP, Toronto, ON 718AB MTCC Description: Purpose: There is limited evidence for the effectiveness of pay for performance despite its widespread use. We assessed whether the introduction of a pay-for-performance scheme for primary care physicians in Ontario, Canada, was associated with increased cancer screening rates and determined the amounts paid to physicians as part of the program. Methods: We performed a longitudinal analysis using administrative data to determine cancer screening rates and incentive costs in each fiscal year from 1999/2000 to 2009/2010. We used a segmented linear regression analysis to assess whether there was a step change or change in screening rate trends after incentives were introduced in 2006/2007. We included all Ontarians eligible for cervical, breast, and colorectal cancer screening. Results: We found no significant step change in the screening rate for any of the 3 cancers the year after incentives were introduced. Colon cancer screening was increasing at a rate of 3.0% (95% CI, 2.3% to 3.7%) per year before the incentives were introduced and 4.7% (95% CI, 3.7% to 5.7%) per year after. The cervical and breast cancer screening rates did not change significantly from year to year before or after the incentives were introduced. Between 2006/2007 and 2009/2010, $28.3 million, $31.3 million, and $50.0 million were spent on financial incentives for cervical, breast, and colorectal cancer screening, respectively. Conclusions: The pay-for-performance scheme was associated with little or no improvement in screening rates despite substantial expenditure. Policy makers should consider other strategies for improving rates of cancer screening.

Presentation by the Recipient of the CFP Best Original Research Article Présentation par le récipiendaire du Prix du MFC pour le meilleur article de recherche originale W123303 Improved Outcomes for Elderly Patients Who Received Care on a Transitional Care Unit 11:15–11:30 Margaret L. Mainville, MD, CCFP, FCFP, Victoria, BC; Michael Klein, MD, CCFP, FCFP, Roberts Creek, BC; Lesley Bainbridge, Vancouver, BC 718AB MTCC Description: Context: Transitional shelters provide safe and temporary accommodation for women in crisis. In 2011/2012, shelters across Canada reported over 60 000 admissions of women. Many of these women have suffered interpersonal violence, complex trauma, and major financial burden. They are at disproportionate risk of health deterioration. To date, little is known about the health care experiences of Canadian women living in shelters. Objective: To explore the health care experiences of women living in Vancouver's transitional shelters, specifically, to 1) determine how health care is accessed; 2) identify specific barriers to access; and 3) examine how the health care system could better serve these women. Design: A qualitative study using focus groups. Participants: Sixteen women residing in two transitional shelters located in Vancouver, British Columbia. Instrument: Three focus groups were conducted to explore the health care experiences of the study participants. Interviews were audio recorded and transcribed verbatim. NVivo software was used for data analysis to help identify units of meaning for key themes. Fndings: Six main themes were identified: Women in transition want family doctors; transportation is a barrier to care; relocation inhibits access; out-of-pocket costs are unaffordable; access to specialists is limited without a GP; continuity of care is highly valued. Conclusions: Conventional health care services are failing women living in transitional shelters, leaving them doctorless and unengaged. While they most often use walk-in clinics, this fragmented care does not meet their complex needs. Given their histories of trauma and crisis, continuity of mental and physical health care is essential. Family physicians should create specific plans to connect with and care for these vulnerable women.

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W108011 A Prospective Comparison of Emergency Department Crowding Scores: A single centre cross11:30–11:45 sectional study Robin Clouston, PGY-2, MD, Saint John, NB 718AB MTCC Description: Context: Emergency department (ED) crowding is a significant problem in emergency care. The most widely known tools to measure crowding are EDWIN and NEDOCS; both validated. The International Crowding Measure in EDs (ICMED), seeks to measure crowding but has not yet been validated internationally. In New Brunswick, there are three tools used in local EDs (DEC, SJRH, Moncton). Objective: To determine which of these 6 tools, as well as 5 single variables, is the best measure of crowding and safety in our local ED, as compared to physician rating via Visual Analogue Scale (VAS). A secondary goal will determine which tool best predicts ED crowding and safety up to four hours before VAS. Design: We conducted observations in crowding capturing all times of day, over 2 weeks, and compared the resultant scores to VAS. Five single variables (#pts in ED; #pts in ED beds/waiting; #pts To Be Seen; # wait room pts; # boarders) were also analyzed. Participants: ED was observed at 2-hour intervals. Charge physicians and charge RNs participated at each interval to give their clinical rating. Intervention: All 11 predictor variables were calculated using a data collection form. Outcome Measure: Physician rating, based on 10cm VAS. A clinician rating is the standard of face validity in ED crowding, based on previous research for EDWIN, NEDOCS and ICMED. Charge nurse rating was used in kappa calculation. Results: We recorded 143 events. VAS showed the ED to be crowded 60.8% of time using a binary cut point. The “#pts waiting” had highest predictive value for crowding at t=0 (sens=81%, spec=64%).

DEC Score had highest predictive value for crowding at t=2h (sens=89.5%, spec=60.0%), with NEDOCS similar (sens=89.5% and spec=53.3%). For safety at t=2h, NEDOCS was most predictive (sens=92.7%, spec=89.5%). No variable could accurately predict crowding or safety at t=4h. For binary crowding VAS, k=0.424. For binary safety VAS, k=0.345. Conclusions: For current ED crowding and safety, single variables are as sensitive and specific as formal crowding scores. In determination of crowding and safety 2 hours in the future, the validated NEDOCS Score and similar DEC Score showed greatest sensitivity and specificity.

WEDNESDAY • MERCREDI

Presentation by the Recipient(s) of the Research Awards for Family Medicine Residents Présentation par les récipiendaires des Prix de recherche pour les résidents en médecine familiale

Presentation by the Recipient(s) of the Research Awards for Family Medicine Residents Présentation par les récipiendaires des Prix de recherche pour les résidents en médecine familiale W121610 11:45–12:00

Melatonin for the Prevention of Delirium and Management of Evening Behavioural Disturbances in Dementia: A systematic review and meta-analysis

Karen Leung, MD, CCFP, Edmonton, AB 718AB MTCC Description: Introduction: Delirium is independently associated with accelerated cognitive decline, prolonged hospitalizations, and mortality among older adults. Currently, few effective pharmacotherapies are available to prevent the onset of delirium or to ameliorate its acute confusional state as well as the chronic agitated behaviours seen in patients with dementia. Melatonin has been proposed as an adjunctive therapy, with early trials suggesting significant reductions in the incidence and symptom severity. Methods: This systematic review examines whether melatonin reduces the incidence of delirium or the severity of evening agitation in patients with dementia. Database searches (1966 to 2014) of MEDLINE, EMBASE, HealthStar, and CENTRAL were conducted without language restrictions. Dersimonian-Laird random effect models were calculated to summarize the pooled relative risks (RR) of delirium and standardized mean differences (SMD) in agitation severity. Results: Five trials examined delirium and six trials examined the severity of dementia associated behavioural disturbances. Although heterogeneity was evident, melatonin use significantly reduced the incidence of delirium (RR=0.43, 095%CI: 0.19-0.96) but did not significantly improve dementiaassociated agitation (SMD=-0.23, 95%CI: -0.87–0.41). No significant adverse events were observed with melatonin use.

Conclusion: Early evidence suggests that melatonin may reduce delirium, but findings need to be interpreted cautiously in the presence of heterogeneity and possible publication bias.

12:00–12:30 12:30–13:00

Lunch / Dîner Section of Researchers Chair’s Report / Rapport du président de la Section des chercheurs

718ab mTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Presentation by the 2015 Family Medicine Researcher of the Year Présentation par le récipiendaire du Prix du Chercheur de l’année en médecine familiale pour 2015 W121614 13:15–13:45

Complexity and Future of Family Medicine Research oss Upshur, MA, MD, MSc, MCFP, FRCPC, Toronto, ON R 718ab mTCC

W101719 Master of the Universe: Can I be a better educator?

13:15–14:30 P. Yee-Ling Chang, MD, MScCH, CCFP, FCFP, Toronto, ON; Jean Hudson, MD, MScCH, CCFP, FCFP, Mississauga, ON; Abbas Ghavam-Rassoul, MD, MSc, CCFP, FCFP, Toronto, ON 715B MTCC Learning objectives: 1. formulate a personal list of academic career goals 2. incorporate faculty development activities to help achieve career goals 3. design three personal strategies to strengthen confidence and competence in medical education Description: More and more faculty members are questioning the wisdom of “see-one-do-one-teach-one” methodology. The response to this awakening has been an increase in the number of opportunities for faculty development in the area of medical education. Faculty can now choose between a variety of options ranging from online resources, workshops, certificates, fellowships, and / to graduate degrees. In addition, goals of faculty differ, depending on their career stage and their other professional responsibilities.

This workshop will begin by asking faculty to reflect on their relative strengths by reviewing the College's Fundamental Teaching Activities Framework. We will review case examples of faculty members who have undertaken Master’s level work and leadership opportunities available to them.

Discussions on how faculty members managed personal and other career obligations, as well as empirical and evidentiary impact of this training on one’s professional career, will be reviewed.

Participants will engage in small-group activities to share and expand their individual goals and develop action plans to achieve them. We will conclude the session by reflecting upon these plans and creating opportunities to establish supports through mentorship and developing a community of learning.

W107079 13:15–14:30

Family Medicine Residents‘ Perceptions of Patient-Centred Care: Is it time to make the implicit, explicit?

Elaine Van Melle, PhD, Kingston, ON; Nancy Dalgarno, PhD, Kingston, ON 713B MTCC

Learning objectives: 1. describe Stewart et al‘s 2014 patient-centred care framework 2. compare and contrast patient-centred care, person-focused care, and relationship-centred care 3. recognize how values shape approaches to patient-centred care and describe potential teaching and learning strategies regarding patientcentred care Description: Across the globe, family medicine has adopted patient-centred care (PCC) as a core value. To date much of the research has focused on developing instruments that measure PCC. Little is known, however, about residents‘ insight into PCC. The purpose of our research was to explore family medicine residents‘ perceptions of PCC, particularly the learning experiences that contribute to the development of their awareness. We chose the patient-centred clinical method (PCCM) as our conceptual framework. Consisting of four integrated components and a series of elements, this framework is widely used in the context of family medicine. In this highly interactive workshop we will share the findings of our research and implications for teaching in residency education. We will begin with a brief presentation of the purpose of our research. Participants will then be asked to write down on large sticky notes what they think are the main components, ingredients, and behaviours contributing to patient-centred care. As a group we will then construct a concept map of patient-centred care. This map will be compared to Stewart et al‘s 2014 patient-centred care framework and lead to a discussion of the difference between patient-centred care, person-focused care, and relationship-centred care and how our values inform how we practise patient-centred care. We will finish by comparing the group‘s work to our analysis of how family medicine residents characterize patient-centred care. At the end of the workshop we will discuss our recommendation that it could be time to make the implicit explicit when it comes to teaching family medicine residents about patient-centred care.

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Kathleen Horrey, MD, CCFP, FCFP, Halifax, NS; Ian Scott, MD, MSc, DOHS, CCFP, FRCPC, FCFP, Vancouver, BC 715A MTCC Learning objectives: 1. describe the benefits of a collegial peer consultative review for educational programs, including national collaboration with the sharing of best practices and feedback on new initiatives 2. apply these lessons learned to one‘s local environment in order to develop a framework for implementing similar collegial peer consultations in a variety of different learning and practice settings Description: The Undergraduate Education Committee (UGEC) of the CFPC has conducted peer consultative reviews of family medicine undergraduate education programs since 2008, in collaboration with the members of the Canadian Undergraduate Family Medicine Education Directors (CUFMED). In this workshop, we will share the outcomes of the first cycle of peer consultative reviews across the country (2008–2014), including the experiences of the peer consultants and the accreditation teams, who had the perspectives of an undergraduate educator for the postgraduate accreditation surveys. These peer consultations were carried out in conjunction with the CFPC Postgraduate Family Medicine Education accreditation visits, whereby a member of CUFMED reviewed the peer‘s undergraduate education program. The aim of the peer consultative review is to provide feedback on existing educational programs within national contextual norms, and consultation on areas of uncertainty or ideas for future implementation and the resources required for sustainability. The peer consultant meets with a variety of local stakeholders who influence the work of the undergraduate education team, including students, staff administrators, the department chair, members of the Family Medicine Interest Group, and the associate dean of the MD program at the school, in an effort to provide review and feedback on information gathered from a variety of perspectives. We will share how the reports from these peer consultations have been used at local schools to implement revisions or new initiatives, and to generate proposals for more resources to further the work of the undergraduate programs. Participants will share their experiences and will provide guidance on the review process to make it better.

W101309 13:15–15:30

WEDNESDAY • MERCREDI

W118005 Calling on Peers: UGEC‘s Peer Consultative Review Process 13:15–14:30 Amy Tan, MD, MSc, CCFP, Edmonton, AB; David Keegan, MD, CCFP (EM), FCFP, Calgary, AB;

Teaching Professionalism: Collegial conversations with our learners James Goertzen, MD, MClSc, CCFP, FCFP, Thunder Bay, ON 717A MTCC

Learning objectives: 1. describe the contextual nature of professionalism 2. describe the critical role of preceptors in the development of professionalism by their learners 3. apply strategies for addressing learner unprofessional behaviour Description: Although professionalism is a core competency for medical students, residents, and practising physicians, the teaching of professionalism is often haphazard. Professionalism is contextual and best understood as a series of behaviours within a clinical setting rather than personal traits or attributes. Preceptors have a critical role in assisting learners with their professional development.

Lapses in professional behaviour by students and residents are common and are to be expected as they apply and integrate the principles of professionalism within the clinical setting. A lapse provides an opportunity to have a crucial and collegial conversation to better understand the learner‘s context and the rationale for their behaviour. Collegial conversations encourage reflection and assimilation of new professional behaviours.

W101485 13:15–15:30

Accreditation of Postgraduate Programs: Demystifying the process L ouise Nasmith, MD CM, CCFP, FCFP, Vancouver, BC; Keith Wycliffe-Jones, MB, ChB, CCFP, Calgary, AB; Shirley Schipper, MD, CCFP, Edmonton, AB; Judith Scott, Mississauga, ON 714B MTCC

Learning objectives: 1. recognize elements of the PG accreditation process that are relevant to participants‘ situations and roles 2. prepare for an accreditation survey and its various components (eg, PSQ completion, local preparation) 3. develop specific skills needed as a surveyor (eg, interviewing, deliberating) Description: This workshop will review the various elements involved in an accreditation survey visit, from the pre-survey questionnaires (PSQs) to the use of checklists during the actual site visit. Examples of good practices will be shared and discussed. Based on the needs of the participants, small-group exercises will be conducted. These might include how best to fill in a PSQ, how to prepare residents and faculty for a survey visit, how to question residents and faculty during a site visit, and what evidence meets accreditation standards.

By the end of the workshop, it is anticipated that participants, whether members of a program or potential surveyors, will have gained a better understanding of the accreditation process.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE W102578 13:15–15:30

Recognizing Your Hidden Faculty: Integrating and supporting the role of health professional educators in family medicine J udith Peranson, MD, CCFP, MPH, Toronto, ON; Deborah Kopansky Giles, BPHE, DC, FCCS, MSc, Toronto, ON; Ian Waters, MSW, RSW, Toronto, ON

717B MTCC Learning objectives: 1. describe the involvement of health professional educators (HPEs) in family medicine teaching nationally and at the University of Toronto 2. identify common challenges faced by HPEs in medical education 3. identify and showcase strategies for effective integration of HPEs into education activities within clinical teaching units Description: Nationally, the transformation of family medicine teaching units into interprofessional primary care teams has created opportunities for health professional educators (HPEs) to take on new roles as educators in family medicine. However, the integration of HPEs has historically been implemented on an ad hoc, informal basis, with implications for the quality of the education experienced by both learners and teachers. This workshop will provide an environmental scan of the roles, experiences, and challenges faced by HPEs as family medicine teachers, leveraging the growing expertise of members of the HPE Network (HPEN) of the CFPC Section of Teachers and referencing research conducted at the University of Toronto on HPE experiences. Strategies for optimizing HPE integration within clinical teaching units will be offered, with opportunity for participants to share local best-practice examples.

W115052 13:15–15:30

The Preceptor as THE Assessment Tool heresa Van der Goes, MD, CCFP, Vancouver, BC; Tom Laughlin, MD, CCFP, Moncton, NB; T Karen Schultz MD, CCFP, FCFP, Kingston, ON

714A MTCC Learning objectives: 1. develop your understanding as a preceptor of why you are the best judge of competence in your trainees 2. encourage you to explore and challenge the evidence behind this conclusion and suggest the essential programmatic changes that will ensure that your assessment becomes the cornerstone to each learner‘s trajectory toward competence 3. assist you and your program to craft appropriate faculty development to support and enhance preceptors‘ confidence in their ability to recognize and coach to competence Description: As medical education, and postgraduate family medicine in particular, moves increasingly toward competency-based training programs, teachers and programs seek tools and skills that will ensure the appropriate assessment of competence. The challenges to rigorous assessment over the past 30 years have moved medical education toward the development of objective assessment instruments such as OSCEs, enhanced MCQs, SAMPs, and SOOs. These instruments, although useful for assessment, do not tell the whole story and do not translate well into the workplace, which is now recognized as the most authentic environment for assessment for postgraduate training. Objectivity and reliability have been two major constructs in medical education assessment that have been recently scrutinized. We will argue that the most reliable assessment of residents is the day-to-day assessment by experts in the discipline: preceptors in family medicine.

W102517 13:30–15:30

To Brief or Not to Debrief: That‘s facilitation!

Kerry Knickle, LLM (ADR), Toronto, ON; Nancy McNaughton, PhD, Toronto, ON

713A MTCC

Learning objectives: 1. understand the relationship between briefing, debriefing, feedback, and the process of facilitation 2. review a practical facilitation model for small group experiential learning 3. practise effective communication skills and strategies Description: Challenging student behaviours, attitudes, and diverse world views present an opportunity for the educator to develop and consolidate a toolbox of facilitation skills that optimize the learning experience. The experiential needs and practical concerns of the learner and the cultivation of unconditional positive regard are critical considerations for the facilitator. Strong communication, awareness of personal and professional group dynamics, and understanding of the many facets of debriefing and feedback are critical for an effective facilitation process.

Effective facilitation skills within the medical educator repertoire are broadly applicable across a breadth of teaching modalities and practical learning contexts. The transition from lecture hall to small group process is more challenging than many assume. Myriad issues, clinical or theoretical, that arise within the context of small group learning require acknowledgement and discussion, but the ”how” of facilitation always eclipses the ”what.”

W121622 13:45–14:00

Community-Based Primary Health Care Teams: Key messages 718AB MTCC

Description: Each Team will provide a one-minute presentation to the audience highlighting the key finding that will be explained on their poster.

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W105417 15:00-15:15

Disability Profiles in French-Canadians With Affective Symptomalogy Surveyed in Primary Care Settings Nina Nguyen, Montreal, QC

Description: Context: Depression is associated with significant disability but less is known about the contribution of anxiety symptoms to disability. Objective: To examine the disability profiles pertaining to depressive and/or anxious symptomatology (DAS). Design: Data were drawn from the Dialogue Project, an observational study conducted in 64 primary care clinics (Quebec, Canada).

Participants: The sample of 14 833 adults was recruited in primary care clinics’ waiting rooms when consulting a general practitioner for oneself. Instruments: The Hospital Anxiety and Depression Scale (HADS) was used to assess DAS. The World Health Organization Disability Schedule (WHODAS; short 12-item version) was used to assess disability in six domains: mobility, life activities, cognition, social participation, self-care, and getting along. Outcome measures: Respondents were divided in four groups according to their HADS scores: anxious subjects (n = 4667), depressive subjects (n = 2304), anxious-depressive subjects (n = 1785) and control subjects (n = 9543). Results: Preliminary results indicate that depressive subjects, compared to anxious subjects, presented higher levels of disability for all six domains, and anxious-depressive subjects presented the worst loss of functionality. For the social participation domain, multiple logistic regression models showed that anxious subjects (OR = 4.10; confidence interval [CI] 3.72 to 4.52), depressive subjects (OR = 7.50; CI 5.95 to 9.46) and anxious-depressive subjects (OR = 18.62; CI 15.76 to 22.01) were more likely to present disability than control subjects. Conclusions: Depressive symptoms were associated with more disability than anxiety, but comorbid depressive-anxious symptomatology significantly increased disability levels in all domains. Anxious symptoms are also associated with a higher level of disability than the absence of DAS. Recognizing that any type of DAS likely causes disability will further the efforts to improve diagnosis and treatment of common mental disorders in primary care.

W107725 15:00-15:15

WEDNESDAY • MERCREDI

Top 4 Oral Presentations / Les 4 meilleures présentations orales

Exploring the Health Care Experiences of Women in Vancouver's Transitional Shelters: A qualitative study Elena Zoe Paraskevopoulos, BHSc, MD, CCFP, Montreal, QC; Shafik Dharamsi, MSc, PhD, Vancouver, BC; Leo Paraskevopoulos, BHSc, MD, Niagara Region, ON

Description: Context: Transitional shelters provide safe and temporary accommodation for women in crisis. In 2011/2012, shelters across Canada reported over 60 000 admissions of women. Many of these women have suffered interpersonal violence, complex trauma, and major financial burden. They are at disproportionate risk of health deterioration. To date, little is known about the health care experiences of Canadian women living in shelters. Objective: To explore the health care experiences of women living in Vancouver's transitional shelters, specifically, to 1) determine how health care is accessed; 2) identify specific barriers to access; and 3) examine how the health care system could better serve these women. Design: A qualitative study using focus groups. Participants: Sixteen women residing in two transitional shelters located in Vancouver, British Columbia. Instrument: Three focus groups were conducted to explore the health care experiences of the study participants. Interviews were audio recorded and transcribed verbatim. NVivo software was used for data analysis to help identify units of meaning for key themes.

Findings: Six main themes were identified: Women in transition want family doctors; transportation is a barrier to care; relocation inhibits access; out-of-pocket costs are unaffordable; access to specialists is limited without a GP; continuity of care is highly valued. Conclusions: Conventional health care services are failing women living in transitional shelters, leaving them doctorless and unengaged. While they most often use walk-in clinics, this fragmented care does not meet their complex needs. Given their histories of trauma and crisis, continuity of mental and physical health care is essential. Family physicians should create specific plans to connect with and care for these vulnerable women.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Top 4 Oral Presentations / Les 4 meilleures présentations orales W107940 15:00-15:15

Longitudinal Evaluation of Physician Payment Reform and Team-Based Care for Chronic Disease Management and Prevention study

Tara Kiran, Md, Msc, CCFP, Toronto, ON; Alexander Kopp, BA; Rahim Moineddin, PhD; Richard Glazier, MD, MPH, CCFP, FCFP, Toronto, ON 706 MTCC Description: Context: Transitioning primary care physicians from fee-for-service to capitation or blended payments and incorporating teambased care are widely regarded as desirable transformations for patient-centred medical homes, but there are few studies evaluating the effects of these changes. Objective: To assess the impact of capitation payment and team-based care on chronic disease management and prevention by evaluating a large-scale transition of primary care physicians to medical homes in Ontario, Canada. Design: We conducted a longitudinal population-wide study using routinely collected administrative data. We used Poisson regression models to examine the association between type of medical home and diabetes and cancer screening in 2011. We calculated outcomes for each fiscal year between 2001 and 2011 and used a fitted non-linear model to compare changes in outcomes between type of medical home over time. Participants: All Ontario patients enrolled to a medical home in 2011 (N = 10 675 480). Intervention/exposure: Patient enrollment in a team-based capitation, non-team capitation, or enhanced fee-for-service medical home as of March 31, 2011. Outcome measures: Proportion of eligible patients receiving testing for diabetes and screening for cervical, breast, and colorectal cancer. Results: Patients in team-based capitation were more likely to receive recommended testing for diabetes in 2011 than were patients in non-team capitation or enhanced fee-forservice (40%, 36% and 32%, respectively) and this was true even after adjustment for patient and physician characteristics (RR [95% CI] compared to enhanced fee-for-service: team-based capitation 1.22 [1.18 to 1.25]; non-team capitation 1.10 [1.07 to 1.14]). Patients in team-based capitation experienced the greatest improvement in recommended testing for diabetes over time, followed by patients in non-team capitation (absolute difference in improvement [95% CI] compared to enhanced fee-for-service: team-based capitation 10.6% [7.9% to 13.2%]; non-team capitation 4.1% [1.5% to 6.8%]). Patients in team-based capitation experienced the greatest improvement in cervical cancer screening but there were no significant differences in change over time between medical homes for breast and colorectal cancer. Conclusions: The shift to capitation payment and the addition of teambased care in Ontario were associated with moderate improvements in diabetes care but the impact on cancer screening was less clear.

W107964 15:00-15:15

Using Automated, Regularly Extracted Electronic Medical Record (EMR) Data for Intervention Research

Simone Dahrouge, PhD, Ottawa, ON; Danielle Rolfe, RKin, PhD, Ottawa, ON; Laura Muldoon, MD, MPH, FCFP, Ottawa, ON; Jyoti Kotecha, MPA, MRSC, CChem, Kingston, ON; Richard Birtwhistle, MD, MSc, CCFP, FCFP, Kingston, ON; David Barber, MD, PhD, FCFP, Kingston, ON; David Barber, MD, PhD, FCFP, Kingston, ON; Clare Liddy, MD, MSc, PhD, FCFP, Ottawa, ON; Janusz Kaczorowski, MA, PhD, Montreal, QC 707 MTCC Description: Context: The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a multidisease surveillance system that collects quarterly electronic medical record (EMR) health data from over 800 primary care practices across Canada. The data extracted are standardized and used to inform quality monitoring at the practice level, and to conduct epidemiological research using the large dataset. Objective: Assess the feasibility of using CPCSSN to obtain chart data required for use in an intervention, the Cardiovascular Health Awareness Program (CHAP). Design: A pilot evaluation of pre- and post-intervention data extractions.

Participants: Six urban primary care practice sites (three community health centres, three interprofessional capitation-based) and 48 primary care providers (PCP) in Eastern Ontario, Canada, participating in CHAP. Intervention: CPCSSN was used to replace direct chart extraction for four purposes: 1) identify eligible patients: CPCSSN produced a list of all individuals aged over 65 years and their coordinates, which was used to automate CHAP recruitment letters; 2) evaluate participation bias: comparison of participants' and non-participants' baseline data (eg, age, sex, diagnoses, risk factors, attachment to practice); 3) calculate risk scores: lipid profile and diagnoses of hypertension and diabetes were added to CHAP session data to calculate the Framingham and CANRISK scores of participants; 4) assess the intervention impact: 12 months post CHAP, modifiable risk factors (blood pressure, lipids profile, BMI, and waist circumference) will be extracted to assess changes from baseline. Results: 1) CPCSSN identified 3084 seniors; PCP excluded 934 (deceased or too frail/had dementia). 2) Participation bias was assessed successfully.

3) Lipid data to calculate Framingham was available for 94% and 62% of participants in practices with established and new (1 to 2 years) EMR systems, respectively. 4) Intervention impact will be assessed in one year. Discussion/conclusions: The cost of chart extraction often precludes the feasibility of studies relying on clinical data. The growing penetration of EMRs opens the opportunity to use automated processes for data extraction. However, the lack of standards across EMR systems means that one approach cannot be used across practices. The existing processes for data extraction and standardization developed by CPCSSN for 12 EMR vendors can be used to provide accurate data efficiently for studies requiring clinical data extraction.

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W108012 15:00–15:15

Using Archived Resident Data to Improve CaRMS Selection Through Evidence-Based Interview Questions

Michelle Morros, MD, CCFP, Edmonton, AB; David Ross, MD, CCFP, Edmonton, AB; John Chmelicek, MD, CCFP, FAAFP, Edmonton, AB; Paul Humphries, MD, CCFP, FCFP, Edmonton, AB; Fred Janke, MD, CCFP, FCFP, Edmonton, AB; Michel Donoff, MD, CCFP, FCFP, Edmonton, AB; Shirley Schipper, MD, CCFP, Edmonton, AB; Shelley Ross, PhD, Edmonton, AB 709 MTCC

WEDNESDAY • MERCREDI

Free Standing Paper (Oral) Presentations Présentations libres (orales)

Description: Context: Selecting the most appropriate candidates for residency training is crucial. A poor match between a resident and a specialty or program can result in the need for interventions that are costly, time-intensive, and stressful for both the resident and faculty member. Developing better methods of selection of residents should result in a better match between residents and programs.

Objective: In this study, we triangulated evidence from different sources to develop evidence-based interview questions for use in the Canadian Resident Matching Service (CaRMS) selection process. Design: Literature review, data-mining. Intervention/instrument: In Phase 1, a literature review was carried out to determine common factors found among residents who encounter difficulty in training. In Phase 2, files of past residents in difficulty were examined to look for common indicators that could be targeted through interviews. In Phase 3, evidence was triangulated to develop evidence-based interview questions. In Phase 4, an expert panel reviewed the questions multiple times until consensus was reached. Results: The literature review revealed that deficiencies in professionalism, resiliency, and problem-solving approaches were common factors among residents who encountered difficulty in training. The file review confirmed these areas, as well as sincere interest in the specialty. Key papers from the literature review were re-examined to determine if there were validated questions to ask of candidates. Once essential aspects of key factors were identified, a preliminary list of questions was generated. The expert panel reviewed the questions, and questions went through multiple iterations before finalized forms. Lastly, a scoring schematic for the individual questions was determined, which included specific elements to watch for in responses. Informally, faculty reported that they were pleased with the new questions; answers given by candidates were more informative than previously. Additionally, scores for candidates showed greater range than in previous CaRMS rankings, indicating that the new interview questions distinguished between candidates better than previous questions did. Conclusion: While much effort is required to develop evidence-based interview questions, initial results suggest that the new questions better distinguish between candidates. Long-term evaluation will include determining how many residents encounter difficulty in training.

W106060 15:00–15:15

Transition Into Residency of Canadians Studying Abroad: Stigmatization and the clinical practice gap Teresa Cavett, MD, CCFP, FCFP, MEd, Winnipeg, MB 710 MTCC

Description: Competition for seats in Canadian medical schools has led many Canadians to undertake medical education abroad. Systematic barriers make it necessary for internationally educated physicians (IEPs) hoping to practise in Canada to complete postgraduate residencies. To do so, they must transition into new medical education systems. The transitional experiences of IEPs are not well understood.This exploratory phenomenological qualitative study sought the perspectives of 20 recent graduates from the University of Manitoba family medicine residency program. Canadians studying abroad (CSAs) constituted the majority of participants. Participants were drawn from five recent cohorts of residents entering training between 2008 and 2012. Recruitment was intentional, with all identified IEPs from these cohorts invited to participate. A modest snowball effect was noted. Twenty-one per cent of potential participants took part. Participant interviews were inductively coded, employing Initial and Emotion coding. Over 70 codes were identified, grouped into 10 categories, which led to the identification of two major themes: the clinical practice gap and the stigmatization of IEPs. The development of the clinical practice gap is attributed to curricular differences in the timing of graduated clinical responsibility between Canadian and international medical educational systems. Participants perceived that they were stigmatized. They described being labeled, singled out, rejected, and mistreated. They recognized that being Canadian afforded them some invisibility as IEPs, although they could be revealed at any time. They further perceived that those for whom English was a second language or who were from visible minorities could not be invisible. Participants described the presence of dual resident hierarchies, by program of training (Royal College vs CFPC) and by country of training (Canada vs international countries). As IEP family medicine residents, they were assigned low status in these hierarchies. Their experiences are conceptualized as stigmatization.

Many questions remain. What led to the development of this stigmatization? Does the clinical practice gap contribute to perpetuation of this stigmatization? Could pre-residency training mitigate the clinical practice gap? What are the learning needs specific to CSAs? These findings are relevant to the work of program directors and curriculum directors in family medicine.

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE W102688 Strengths in Caring for Patients With Advancing Illness as Opportunities for a Primary Palliative Care 15:15–15:30 Michelle Howard, PhD, Hamilton, ON; Samantha Winemaker, MD, CCFP, Hamilton, ON; Joy White, PHC-NP, BScN, Hamilton, ON; Nicolle Hansen, PHC-NP, MScN, Hamilton, ON; Alex Rewegan, BA, Hamilton, ON; Sharef Danho BSc(candidate), Hamilton, ON

707 MTCC Description: For most people, chronic life-limiting illnesses such as cancer and dementia will result in a period of decline towards end of life that necessitates palliative care. Only one-third of Canadians receive palliative care from specialist teams and most primary care settings do not have a palliative care specialist. The role of family physicians in providing primary palliative care will become increasingly important. Patientcentred comprehensive family medicine equips family physicians and other primary care providers to care for patients with advancing illness as they approach end-of-life. Drawing on their longitudinal relationship, knowledge of the patient’s life circumstances and the patient’s health status puts family physicians in an ideal position to support the transition to palliative care. Handing over all palliative care to palliative care specialists is unsustainable, may result in fragmented care, and diminishes an opportunity for primary care providers to develop the skills and confidence to deliver palliative care. Although family physicians today are delivering palliative care, there are gaps in coverage and room for quality improvement. There are calls in Canada to integrate palliative care in the health care system as part of “comprehensive” family medicine. These calls to action must be interpreted through an understanding of the strategies family physicians currently use to manage their patients with advancing life-limiting illness. Our research suggests that certain primary care provided to patients with advanced lifelimiting illness is not being correctly recognized as palliative care. We will share the results of our qualitative interviews with primary care practitioners, from a diverse array of practices, who have so far elucidated interesting and surprising aspects of what we would consider palliative care. Of particular importance is the establishment of a proactive relationship, as waiting for an event to occur before delivering a palliative approach to care reduces the value and quality of this care. Our data may offer an alternative and more encouraging view of palliative care integration in primary care settings. This session will explore the existence and emergence of indicators reflecting the provision of primary level palliative care.

W104798 The Experience of Primary Care at a Provincial Detention Centre 15:15–15:30 Samantha Green, MD, CCFP, Toronto, ON; Fiona Kouyoumdjian, MD, CCFP, Hamilton, ON; Jessica Foran, Hamilton, ON

705 MTCC Description: Context: Little is known about the health status of Canadian inmates in provincial detention centres or about their access to health care in the community. US and European data show that the health of the incarcerated is poor, with a disproportionate burden of mental illness, infectious diseases, chronic diseases, and premature mortality. Recently released individuals in the US and Europe have been shown to have poor access to primary care. Objective: To describe the primary care experience of adult inmates at the Hamilton-Wentworth Detention Centre. Design: Written surveys were distributed to blocks of men and women at the Hamilton-Wentworth Detention Centre. Inmates were allowed to complete surveys in their cells at any time. Completed surveys were placed in sealed envelopes and returned to the nurse manager. Participants: Adult men and women with working knowledge of English were included in the study. Four hundred nineteen surveys were distributed and 125 were returned (33%). Of the respondents, 16.8% indicated they were female; 80%, male. The mean age was 36 years. Instrument: A two-page survey with multiple choice questions and space for extended written responses. Results/Findings: Among respondents, 38% (P < .001) report that they do not have a family doctor or primary care provider, compared with 15% of the Canadian population. Those with no family doctor noted several barriers, including difficulty finding a physician who is accepting new patients; difficulty navigating the health care system; and frequent incarcerations. Among respondents, 43% reported having had unmet health care needs in the year before coming to jail, compared with 8.8% of the Canadian population. Barriers included prior experience of stigma in the health care system and inaccessible clinic locations and schedules. Participants reported an average of 2.1 emergency department visits in the year prior to incarceration, compared with 0.29 visits per year for the Canadian population. Discussion/Conclusion: Those incarcerated at the Hamilton-Wentworth Detention Centre report having poorer access to primary care and higher unmet health care needs than average Canadians. Incarceration could provide an opportunity to connect inmates with primary care and thus improve health care and health.

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Continuity of Care and Identity Formation: A critical review of interventions in postgraduate training

Allyson Merbaum, MD, CCFP, FCFP, Toronto, ON; Kulamakan Mahan Kulasegaram, PhD, Toronto, ON; Rebecca Stoller, MD, CCFP, FCFP, Toronto, ON; Risa Freeman, MD, MEd, CCFP, FCFP, Toronto, ON

710 MTCC

Description: Context: Continuity of care (CoC) is a critical aspect of practice in generalist disciplines and across several dimensions of clinical care. To date, there have been several interventions at the level of residency training to inculcate CoC. Their mechanisms and impact on the formation of a caring physician identity is unknown. In this critical narrative review, we analyzed the existing literature to understand the pedagogic rationales and effectiveness of these interventions. Method: We searched the existing medical education literature via MEDLINE, EMBASE, and CINAHL for English-language articles since 1975 that described or evaluated continuity-ofcare interventions at the level of postgraduate training. We excluded commentaries and non-postgraduate papers. We analyzed the extracted literature for themes across interventions, for the proposed pedagogic mechanisms or rationales, and for evidence of effectiveness. Results: Twenty-two papers dealt with CoC at the postgraduate level but only 15 described interventions, with the remaining describing satisfaction with training. Studies describing interventions have focused on organizational changes to the structure of residency programs. Examples of such interventions included a longitudinal family medicine component, a resident patient panel, and increasing dedicated time for practice in family medicine settings. There is a lack of rigorous evaluation of most interventions. Our analysis suggests that the pedagogic mechanisms are not clearly articulated in the literature. Furthermore, current structural interventions do not conceptualize continuity of care as a part of the identity of the physician. Conclusions: Pedagogic evidence suggests that to be effective training must help integrate the practice of CoC as an essential part of physician identity.

Current interventions in the literature do not describe a programmatic approach to integrating CoC into emerging physician identity and have not been rigorously evaluated for outcomes. Adopting an identity formation framework can help training become more relevant and transferrable to future practice, and suggest appropriate outcomes for evaluation.

WEDNESDAY • MERCREDI

W106309 15:15–15:30

W108008 Mental Health Screening in Pregnancy: Methods women prefer; barriers and facilitators to disclosure 15:15–15:30 Anne Biringer, MD, CCFP, FCFP, Toronto, ON; Marie-Paule Austin, MD, FRCP, Victoria, Australia; Sheila McDonald, PhD, Calgary, AB; Maureen Heaman, RN, PhD, Winnipeg, MB; Gerri Lasiuk, RN, PhD, Edmonton, AB; Katherine Hegadoren, RN, PhD, Edmonton, AB; Sarah D. McDonald, MD, FRCSC, MSc, Hamilton, ON; Sander van Zanten, MD FRCPC, Edmonton, AB; Wendy Sword, RN, PhD, Hamilton, ON; Rebecca Giallo, PhD, Victoria, Australia; Dawn Kingston, RN, PhD, Edmonton, AB 704 MTCC Description: Context: Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening.

However, despite recommendations by international organizations, fewer than 20% of prenatal care providers routinely conduct mental health screening. A prominent barrier is providers’ perceived concern regarding the acceptability of screening and its results to women. Objective: To describe pregnant women’s views of mental health screening, including screening methods and personal and system-related barriers and facilitators that influence their responses to provider-initiated mental health screening. Design: Multisite, cross-sectional survey. Setting: Five maternity clinics and prenatal classes at two community hospitals in Edmonton and Medicine Hat, Alberta, Canada. Participants: All pregnant English-speaking women presenting for care in the seven sites were recruited consecutively. Intervention: Self-report questionnaire completed on computer tablet. Results: Of 500 women approached, 460 (92%) participated. Overall, 98% were very (75%) or somewhat (23%) comfortable with being asked about their mood in pregnancy. Women were most comfortable with paper-based (>90% very or somewhat comfortable) and computer-based (>83%) screening that was coupled with discussion of results with their provider. Comfort levels were similar whether the screening was completed in clinic or home. Telephone-based screening by a nurse was least favoured (62% very or somewhat comfortable).

Significant barriers to disclosure included others' normalizing emotions, desiring to handle their mood on their own, preferring to discuss feelings with significant others, and not knowing what emotions were "normal." Significant facilitators included characteristics of the care provider (sensitive, interested), reassurance that emotional health was part of normal care, hearing that other women have emotional issues in the perinatal period, and reassurance that help (in addition to medications) is available. Conclusions: Women are receptive to a variety of screening approaches. Efforts to minimize barriers and enhance facilitators of screening are key strategies in implementing universal, routine perinatal mental health screening.

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE W108016 Examining Past Resident Files to Improve CaRMS Selection Through an Evidence-Based File 15:15–15:30 Review Process Michelle Morros, MD, CCFP, Edmonton, AB; Rosslynn Zulla, MEd, Edmonton, AB; Lisa Steblecki, MD, CCFP, Edmonton, AB; Sandra Robertson, Edmonton, AB; Shelley Ross, PhD, Edmonton, AB

709 MTCC Description: Context: Despite best efforts in selection, 6% to 10% of accepted residents in family medicine experience difficulties. Interventions can be time-consuming and expensive. One strategy to reduce the number of interventions needed is to improve the resident selection process, ensuring that the best match possible is being made between resident and program. Objective: The Canadian Residency Matching Service (CaRMS) applications of past residents who encountered difficulty were examined to determine if there were common indicators of difficulty.

The goal was to use these data to develop an evidence-based CaRMS file review process. Design: Secondary data analysis, literature review.

Instrument: Program directors identified 30 residents who encountered difficulty (“cases”). Matched controls (residents who did not encounter difficulty; “controls”) were also identified. Outcome measures: CaRMS application materials were extracted from resident files (de-identified and coded). Each component of the CaRMS application was analyzed, with a focus on differences within the application elements between the residents who encountered difficulty and those residents who did not. Factors were triangulated with existing findings in the literature.

Results/findings: Multiple indicators were identified (commonalities among cases/notable differences between cases and controls); several reflected findings in literature. In the curriculum vitae section, cases did not have much variety in their work or volunteer roles, and had few leadership positions. For clinical electives, total time was less of an indicator than was the degree to which applicants described their electives. Cases gave vague descriptions, while controls gave detailed descriptions. For reference letters, there were certain words that occurred with much greater frequency for the controls, such as “exceptional” and “well-rounded.” For the personal letter, cases were more likely to be vague, especially about specialty choice, and have inconsistencies within the personal letter. Controls had highly descriptive personal letters that emphasized and gave supporting evidence for specialty choice. The new file review form was piloted with 10 faculty reviewers and their current residents. Greater agreement was seen than with the previous form. Conclusions: The new evidence-based form shows promising results in pilot use. Long-term evaluation of the 2015 cohort will indicate if this process is valid as a better way to select residents.

W108072 15:15–15:30

Using Narrative to Enhance Team-Based Care in Older Adults Who Have Fallen Lara Nixon, MD, CCFP, FCFP, Calgary, AB; Laurie Pereles, MD, MSc, CCFP, FCFP, Calgary, AB

706 MTCC

Description: Context: Falling as an older adult is a common and complex phenomenon with potentially serious consequences; however, there has been a relatively low uptake and acceptance of falls prevention strategies in this population. Clinical approaches are needed to identify factors that may facilitate or impede older adults’ acceptance of risk status and need for intervention. Objective: We hypothesize that a narrative approach to interviewing older people who have fallen will reveal important gaps compared to clinical history-taking that could better inform collaborative clinical decision-making. Design: A series of comparative case studies based on a convenience sample of fifteen older adults referred to a falls prevention clinic was used, each including the: 1) patient narrative elicited by a member of the research team; 2) clinical history generated by the falls clinic team; and 3) clinicians’ impressions elicited through team interviews. We compared these three components within and across cases using thematic analysis to generate an enriched understanding of each participant’s experience of falling.

Strategies used to improve trustworthiness included: field notes, verbatim transcription, member checking, audit trail of analysis meetings, presentation of preliminary findings to multidisciplinary audiences, and external review. Findings: Three key concepts emerged from patient narratives: 1) perception of falls etiology, internal vs external locus of control; 2) significance of fall; and 3) perceived need for and benefit/ risks of action. Interviews with the falls clinic team identified instances of salient information in patient narratives that was missed by clinical history taking or noted, but excluded from the clinical report for a variety of reasons. Whether the missing narrative information was due to failing to elicit or opting to not report, falls team clinicians confirmed that the inclusion of this missed information may have resulted in more holistic understanding of patient context and facilitated collaborative management, particularly in patients not readily engaging with falls prevention strategies. Conclusion: Important insights into older adults’ experiences with having fallen were revealed using a narrative approach. In concert with clinical history taking, a narrative approach could be of particular use with patients who do not readily accept interventions based on traditional falls risk assessments.

W101716 15:30–15:45

IV Opiate-Assisted Treatment (iOAT): Participants’ characteristics might impact intensive treatment Options LD. Scott MacDonald, MD, Vancouver, BC

704 MTCC

Description: For opioid-dependent patients not benefiting from conventional treatments (ie, oral methadone), evidence suggests that supervised injectable medications are effective. This baseline analysis aims to describe participants’ characteristics at entry into a study comparing injectable diacetylmorphine and hydromorphone and factors independently associated with prior access to methadone at high doses. SALOME is a phase III, randomized, double-blind controlled trial comparing injectable diacetylmorphine and hydromorphone in 202 chronic, opioiddependent, current injection-opioid users in Vancouver who had at least one prior episode of opioid maintenance treatment. An analysis has been done to determine characteristics associated with reaching a stable dose of oral methadone in the five years prior to trial recruitment.

These data emphasize that study participants were in need of alternative treatments at the time of enrolment and fit the profile of patients to whom supervised injectable treatment should be offered. Implications of prior methadone treatment experience in these individuals who might be eligible for injectable opioid-assisted treatment (iOAT) will be reviewed.

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Siavash Jafari, MD, MHSc, FRCPC, ASAM, Vancouver, BC

705 MTCC Description: Context: Our patients tell us they are using marijuana for period symptoms but there is no reported evidence for gynecologic indications. There is evidence for cannabinoid receptors in the uterus. Before starting clinical trials, we need to know how marijuana is being used. Objectives: To understand how women have been using marijuana for relieving the pain and other symptoms of menstrual periods. Methods: Questionnaires were provided online and on paper to marijuana vendors in retail shops in Vancouver, and to women recruited through the shops; by word of mouth; from advocacy groups; and using a classified advertisement website (Craigslist). The vendors were asked if they had recommended marijuana for period symptoms and how it was used. The women’s questionnaire asked demographics plus whether the respondent had (current or past) pain with her periods, whether she had ever used marijuana for her period pain, and, if so, how she used it (smoked, eaten, etc.) and if she had experienced any benefit. Results: There were 192 out of 201 usable questionnaires received from women and nine from vendors. The mean age of respondents was 30.9 years with a range of 18 to 62 years. The worst period pain reported was a mean of 8.3 out of 10 and usual period pain was 5.9 out of 10. Women also complained of headaches (66.7%), nausea (54.2%), diarrhea (50.5%), feeling angry (27.1%), dizziness (66.1%), feeling sad (66.1%), fever/chills(25.5%), weakness (56.3%), and vomiting (20.3%). For period symptoms, 170 women (88.5%) said they had used marijuana and 152 (89.4%) said it helped. One hundred fifty-three women (79.7%) said they knew other women who used marijuana for periods. Eight of the nine vendors had been recommending marijuana and all said it helped their clients. Women had been using it in many forms, however, mostly they smoked or ate it. Specific recommendations from the women included using high-CBD (cannabidiol), low-THC (delta-9-tetrahydrocannabinol) forms and titrating doses so that it allowed women to function. Conclusions: Many women are using marijuana successfully to relieve the symptoms of menstrual periods. Clinical trials are needed to assess if low-THC, high-CBD products are helpful, because they may have fewer side effects and risks.

W107400 15:30–15:45

WEDNESDAY • MERCREDI

W107286 Women’s Experience Using Marijuana to Cope With the Pain and Other Symptoms of Menstrual 15:30–15:45 Periods Ellen Wiebe, MD, CCFP, FCFP, Vancouver, BC; Beata Byczko, MD, Vancouver, BC;

Use of Cognitive Task Analysis to Support Change Management Lee Green, MD, MPH, Edmonton, AB

707 MTCC

Description: Context: Our patients tell us they are using marijuana for period symptoms but there is no reported evidence for gynecologic indications. There is evidence for cannabinoid receptors in the uterus. Before starting clinical trials, we need to know how marijuana is being used. Objectives: To understand how women have been using marijuana for relieving the pain and other symptoms of menstrual periods. Methods: Questionnaires were provided online and on paper to marijuana vendors in retail shops in Vancouver, and to women recruited through the shops; by word of mouth; from advocacy groups; and using a classified advertisement website (Craigslist). The vendors were asked if they had recommended marijuana for period symptoms and how it was used. The women’s questionnaire asked demographics plus whether the respondent had (current or past) pain with her periods, whether she had ever used marijuana for her period pain, and, if so, how she used it (smoked, eaten, etc.) and if she had experienced any benefit. Results: There were 192 out of 201 usable questionnaires received from women and nine from vendors. The mean age of respondents was 30.9 years with a range of 18 to 62 years. The worst period pain reported was a mean of 8.3 out of 10 and usual period pain was 5.9 out of 10. Women also complained of headaches (66.7%), nausea (54.2%), diarrhea (50.5%), feeling angry (27.1%), dizziness (66.1%), feeling sad (66.1%), fever/chills(25.5%), weakness (56.3%), and vomiting (20.3%). For period symptoms, 170 women (88.5%) said they had used marijuana and 152 (89.4%) said it helped. One hundred fifty-three women (79.7%) said they knew other women who used marijuana for periods. Eight of the nine vendors had been recommending marijuana and all said it helped their clients. Women had been using it in many forms, however, mostly they smoked or ate it. Specific recommendations from the women included using high-CBD (cannabidiol), low-THC (delta-9-tetrahydrocannabinol) forms and titrating doses so that it allowed women to function. Conclusions: Many women are using marijuana successfully to relieve the symptoms of menstrual periods. Clinical trials are needed to assess if low-THC, high-CBD products are helpful, because they may have fewer side effects and risks.

W107719 15:30–15:45

Assessing the Needs of Family Physicians Caring for Cancer Survivors: A Montreal survey Genevieve Chaput, MD, MA, CCFP, Montreal, QC; Desanka Kovacina, MD, CCFP, Montreal, QC

706 MTCC

Description: Context: Due to earlier detection and better treatments, the number of cancer survivors has risen significantly in the past three decades. In addition to higher risk of recurrence or second malignancy, over 50% of survivors are afflicted with late effects. Cancer survivors visit a wide variety of specialists during treatment, yet 75% of them also see their family physician (FP), and this proportion does not decrease after treatment. Upon treatment completion, FPs are expected to play an integral role in cancer survivors’ care.

However, literature reveals low confidence levels in family physicians with regards to survivorship care. Furthermore, major deficits currently exist in the transition of care from specialists to FPs. Objective: In 2014, we conducted a survey targeting FPs, which aimed to identify their needs and perceived barriers in providing optimal care to cancer survivors. Design: A brief survey containing Likert-

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE type and short-answer questions was designed and distributed to FPs practising within academic, public, and private settings in Montreal, Canada. Based on a targeted FP population estimated at 500, sample size was set at 75. Survey design aimed to identify specific outcome measures including current needs and perceived barriers to cancer survivor care. Data analysis comprised descriptive statistics, an opencoding approach to identify major themes, and Student t-tests. Ethics approval was obtained. Results: Of 165 surveys distributed, 93 were completed, for a 56.3% response rate. Among respondents, 94% were already caring for cancer survivors, and of these, 73% expressed a willingness to take on new cancer survivors. A statistically significant number of FPs disagreed more than agreed to “receiving summary reports” (P = .001), as well as for “familiar with guidelines” (P = .01). The biggest barriers to cancer survivor care were lack of communication with specialists (53%), and lack of knowledge of survivorship care (36%). Conclusion: Our findings demonstrate the need to improve communication with specialists, as well as to educate FPs about survivorship. In response, a MAINPRO-accredited pilot workshop was created and has thus far been delivered to 123 FPs at four sites. Preliminary findings indicate high relevance of pilot content (95%).

W107999 Patient Safety in Family Medicine Residency: A thematic content analysis of accreditation standards 15:30–15:45 and curriculum objectives Aliya Kassam, MSc, PhD, Calgary, AB; Nishan Sharma, EdD, Calgary, AB; Pierrette Leonard, APR, FCPRS, Ottawa, ON; Maeve O'Beirne, PhD, MD, CCFP, Calgary, AB

710 MTCC Description: Context: Remediation of residents who encounter difficulty is costly and time intensive, more so when problems have been occurring for an extended time; it is also stressful for family medicine clinical faculty. Improvement in identification of residents in difficulty is one of the goals of competency-based assessment, and was one of the objectives when we implemented the Competency-Based Achievement System (CBAS) in our residency program in 2009. Through improved detection of residents who are struggling, we can improve training outcomes.

Objective: To determine if there has been a change to rotation flag patterns for residents experiencing difficulty pre- and post-implementation of CBAS. Design: Secondary data analysis (descriptive comparative cohort study) using archived resident data files (three years pre-CBAS implementation, and three years post-CBAS). Setting: Large Canadian family medicine residency program. Participants: Archived files were examined for all residents in the 2005-2007 and 2009-2011 entry cohorts (Total N= 393). Main and Secondary Outcome Measures: Files were searched for evidence of flags on In-Training Rotation Evaluations (ITERs) and Summative Progress Reports. Results: Overall, the total number of ITERs with flags has decreased since implementation of CBAS (40% in 2005 to 17% in 2011); as well, there has been a steady increase in flagged residents who are remediated (from a low of 4% in 2006 to 23% in 2011). Total remediations have decreased from 8% in 2005 to 4% in 2011. Rotations where residents are likely to be flagged have mostly remained constant (family medicine, obstetrics, pediatrics, critical care, internal medicine), with the exceptions of general surgery and orthopedics. Conclusions: Post-CBAS, residents in difficulty appear to be detected earlier, and problems are addressed more quickly. This may be due to CBAS resulting in more detailed comments from the preceptors, leading to resolution of existing issues quicker by making the resident aware of their deficiencies and providing resources to overcome those difficulties. Overall, implementation of CBAS appears to have increased the likelihood that residents encountering difficulty obtain the attention they require earlier in their training, resulting in fewer flags on rotations.

W108022 15:30–15:45

Trends in Resident Rotation Flags Before and After Implementation of the Competency-Based Achievement System Shelley Ross, PhD, Edmonton, AB

709 MTCC

Description: Background: The College of Family Physicians of Canada (CFPC) is responsible for setting standards for accreditation and the curriculum that individual family medicine residency training programs must follow. There are no specific criteria for patient safety and quality improvement content at this level. Objective: To conduct a thematic analysis of the CFPC's current documentation for accreditation (The Red Book) and family medicine curriculum (Triple C Reports 1 and 2) with respect to patient safety competencies as outlined by the Canadian Patient Safety Institute (CPSI). Method: Thematic analysis of the family medicine (FM) competencies was conducted as outlined by the Triple C curriculum (using the Four Principles of Family Medicine, the CanMEDS-Family Medicine framework, and an in-depth curriculum guide for implementation), as well as by overarching Red Book standards for accreditation and enhanced skills training programs, with respect to the six CPSI patient safety competencies. The CPSI patient safety principles were used as nodes to which the CFPC documentation was coded by two researchers. Researchers met to discuss any discrepancies in coding until consensus was reached. Results: Across the CFPC documentation, the most commonly found patient safety competencies were work in teams (n = 24 coding references) and create a culture of patient safety (n = 23 coding references). The least commonly found patient safety competencies were "optimize factors" (n = 1 coding references) and "recognize, respond to, and disclose adverse events" (n = 1 coding references). The patient safety competency of "manage safety risks" was also not common (n = 5 coding references). Conclusions: A relevant framework for patient safety and quality improvement education is needed for family medicine residency training programs across Canada. This framework should focus on optimizing human factors and disclosing near misses/adverse events, as well as on managing patient safety risks in primary care. This is to ensure that programs address patient safety across the full continuum of care, including community-based care. Standards for accreditation and the curriculum from CFPC could help to create a patient safety culture in family medicine training. Future research should include a needs assessment of family medicine residency training programs with regards to patient safety and quality improvement content.

W95286 15:45–16:00

The BC Clinical Care Management (CCM) Initiative as a Case Study in Large-Scale Change Carol Herbert, MD, CCFP, FCFP, FCAHS, Vancouver, BC; Allan Best, PhD, Vancouver, BC

707 MTCC

Description: Context: The British Columbia Ministry of Health’s Clinical Care Management (CCM) initiative was used as a case study to better understand large-scale change within BC’s health system. Eleven guidelines have been introduced into hospitals across all BC health authorities fmf.cfpc.ca

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W106807 15:45–16:00

WEDNESDAY • MERCREDI

in an attempt to improve evidence-based clinical practice. Fifteen additional CCM guidelines are to be implemented over the next three years, with many priorities touching on family medicine. Objective: Using a complex system framework, this study examined mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design: Qualitative descriptive. Participants: Purposively selected respondents in each health authority; three purposively selected guidelines.

Intervention: Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers, and board members were validated through an online survey. Findings: The functional themes for managing large-scale clinical change included creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications, and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Discussion: Recommended actionoriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication, especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Conclusions: Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in large-scale change.

Relational Continuity Experiences of Residents and Preceptors in a Family Medicine Residency nn Lee, MD, MEd, CCFP, Edmonton, AB; Shelley Ross, MA, PhD, Edmonton, AB; A Sandra Robertson, MN, Edmonton, AB; Sheny Khera, MD, MPH, FCFP, Edmonton, AB

709 MTCC Description: Context: Relational continuity is defined as the “ongoing therapeutic relationship between a patient and one or more providers.” It has been found to be a predictor of positive outcomes for both patients and physicians. Given this, teaching and modeling relational continuity in family medicine residency training is highly important. The challenge lies in how to measure relational continuity for residents in training programs. Objectives: To determine to what extent the electronic medical record (EMR) is a useful tool in understanding relational continuity experiences of family medicine residents. To determine relational continuity experiences of family medicine residents at the end of a two-year residency and the factors influencing the opportunities for developing relational continuity between residents and patients. Design: Mixed methods. Participants: Purposive sample of residents (n = 5) and preceptors (n = 5) at an academic teaching clinic. Instruments: EMR data was used to measure relational continuity. A constructivist grounded theory approach was used to conduct semistructured interviews with all participants, and constant comparative analysis was used to determine factors that influence relational continuity for residents. Outcome measures: Quantitative: Relational continuity, as determined by the Usual Provider Continuity (UPC) Index, a commonly used measure of continuity of care (ratio of patient visits to usual care provider). Results/Findings: Residents were found to have relatively low relational continuity. For most residents, 49.3% to 67.5% of patients were in the UPC Index of 0 to 0.24, and a low proportion of patients were seen at a UPC index of 0.50 or greater.

Qualitative findings resulted in a model of relational continuity, where continuity of care in family medicine, relational continuity with patients, therapeutic alliance, and ownership all interacted and were affected positively or adversely by program and systems factors, patient factors, and attitudes and experiences of both the resident and the preceptor. Conclusions: EMR data provide a good picture of continuity rates. However, the factors that affect relational continuity can only be found by interviewing residents and preceptors. While most residents valued relational continuity, factors such as patient schedules and program or system factors made it difficult to establish high rates of continuity with patients.

W107244 15:45–16:00

Facilitators, Barriers, and Strategies for Clinical Faculty Conducting Research: A qualitative study Bridget L. Ryan, PhD, London, ON, Cathy Thorpe, MA, London, ON; Stephen J. Wetmore, MD, MClSc, CCFP, FCFP, London, ON; Merrick Zwarenstein, MBBCh, MSc, PhD, London, ON; Jamie Wickett, MD, CFPC, London, ON

710 MTCC

Description: Context: Research skills empower family physicians to produce and appraise new knowledge and to evaluate improvements in their clinical work. The College of Family Physicians of Canada, Section of Researchers has developed a blueprint for family medicine research success with the vision that research is a core component of training, scholarship, and clinical practice. This context is the impetus for developing a program for building research culture and capacity in the Department of Family Medicine at Western University. This study represented the first step in the design of our research capacity development initiative. The objective of this descriptive qualitative study was to describe facilitators, barriers, and strategies for clinical faculty to conduct research. Method: Key informant interviews were conducted with 10 members of the department with different roles: clinician-teachers, researchers, administrative leaders, and research staff. Interviews were audio-recorded and transcribed verbatim. Interviews were analyzed individually by two team members, who identified themes, and then reviewed by the entire team, where themes were further elaborated and refined. Findings: Findings were organized around individual, organizational, and external factors that acted as facilitators and barriers to clinical faculty research, and around the success and limitations of research capacity development initiatives already in place. Individual themes centred on motivation and the knowledge, skills, and confidence necessary for clinical teachers to conduct research. Organizational themes included the need for role clarity, collaborations, and organizational support.

External themes focused on organizations both within and outside the university setting, including the College of Family Physicians

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE of Canada. Conclusion: These results are being used to design a strategy for strengthening research capacity among clinical faculty in the Department of Family Medicine at Western University. The ultimate goal is to enhance research culture, as measured by increased research interest, skills and confidence, and institutional support; and to increase research capacity, measured by publications and presentations. These findings will be of interest to other departments of family medicine in Canada interested in building research culture and capacity.

W107250 Effect of Continuity of Care in Primary Health Care on Hospitalization and Emergency Department 15:45–16:00 Use

Yvonne Rosehart, Ottawa, ON; Tanya Flanagan, Toronto, ON; Geoff Ballinger, Ottawa, ON;

Geoff Ballinger, Ottawa, ON; Lili Liu, Ottawa, ON; Gladys Osien, Ottawa, ON; Husam Alqatami, Ottawa, ON

706 MTCC

Description: Context: Research skills empower family physicians to produce and appraise new knowledge and to evaluate improvements in their clinical work. The College of Family Physicians of Canada, Section of Researchers has developed a blueprint for family medicine research success with the vision that research is a core component of training, scholarship, and clinical practice. This context is the impetus for developing a program for building research culture and capacity in the Department of Family Medicine at Western University. This study represented the first step in the design of our research capacity development initiative. The objective of this descriptive qualitative study was to describe facilitators, barriers, and strategies for clinical faculty to conduct research. Method: Key informant interviews were conducted with 10 members of the department with different roles: clinician-teachers, researchers, administrative leaders, and research staff. Interviews were audio-recorded and transcribed verbatim. Interviews were analyzed individually by two team members, who identified themes, and then reviewed by the entire team, where themes were further elaborated and refined. Findings: Findings were organized around individual, organizational, and external factors that acted as facilitators and barriers to clinical faculty research, and around the success and limitations of research capacity development initiatives already in place. Individual themes centred on motivation and the knowledge, skills, and confidence necessary for clinical teachers to conduct research. Organizational themes included the need for role clarity, collaborations, and organizational support. External themes focused on organizations both within and outside the university setting, including the College of Family Physicians of Canada. Conclusion: These results are being used to design a strategy for strengthening research capacity among clinical faculty in the Department of Family Medicine at Western University. The ultimate goal is to enhance research culture, as measured by increased research interest, skills and confidence, and institutional support; and to increase research capacity, measured by publications and presentations. These findings will be of interest to other departments of family medicine in Canada interested in building research culture and capacity.

W107807 Effectiveness of Maintenance SSRI Teatment in Primary Care Depression to Prevent Recurrence: 15:45–16:00 Randomized controlled trial Dee Mangin, MB ChB, DPH, FRNZCGP, Hamilton, ON; Claire Dowson, PhD, Christchurch, NZ;

Roger

Mulder, MD, Christchurch, NZ; Elisabeth Wells, PhD, Christchurch, NZ; Les Toop, MD, Christchurch, NZ; Tony Dowell, MD, Wellington, NZ; Bruce Arroll, MBChB, PhD, Auckland, NZ; Evan Begg, MBChB, PhD, Christchurch, NZ

704 MTCC Description: Context: The increasing SSRI prescription numbers in the population are being driven in part by continuation of medication after acute treatment as maintenance therapy to prevent recurrence. Most depression is treated in the primary care setting. There is no evidence from randomized controlled trials of the effectiveness of this long-term maintenance treatment in primary care patients. Objectives: 1) To assess the effectiveness of long-term maintenance treatment with fluoxetine in prevention of depression recurrence in primary care. 2) To compare outcomes at 18 months for those who trialed discontinuation, compared to those who did not. Design: Multicentre doubleblinded randomized controlled trial. Intervention: Ongoing maintenance fluoxetine treatment compared with tapered withdrawal to placebo. Participants: Participants identified from electronic medical records' prescribing data had initial eligibility screening by their family doctors: they were aged 18 to 75 years, had historical diagnosis of depression, and were taking fluoxetine as maintenance treatment to prevent recurrence for at least 15 months. Follow-up: Weeks 1, 2, and 4, and months 3, 6, 9, 12, 15, and 18 to monitor recurrence, side effects, withdrawal effects, other reasons for exiting treatment, and general functioning. Primary outcome: Recurrence of depression over 18 months. Secondary: Comparison of all outcomes at 18 months for those who trialed withdrawal with those who did not. Results: Among identified patients, 33% (419/1273) responded to the invitation to participate. Of these, 156 were ineligible or did not consent, and 263 were randomized into taper and continuation arms. There were 30 (23.3%) depression recurrences in the taper arm and 14 (10.5%) in the continuation arm (absolute difference 12.8%; 96% CI 3.4% to 2.3 %; P = .005). For every 17 patients taking maintenance antidepressant medication, 1 was unable to discontinue because of withdrawal symptoms. At 18 months, 47% of the taper group and 4% of the continuation group were no longer taking antidepressants (absolute difference 43% [96% CI 33% to 53%]). Conclusions: The absolute benefit (12.8%) is similar to that for acute treatment. Most patients taking maintenance antidepressant medication experienced no benefit over 18 months. It seems reasonable to present these data to patients and offer a trial of discontinuation: the NNTrial for one patient to successfully discontinue medication at 18 months is 2. There was no difference in outcome measures at 18 months for those who trialed discontinuation.

W108050 15:45–16:00

Closing the Gap: Enhancing knowledge and access to clinical prevention services for South Asian population

Rachel Douglas, MPH, Surrey, BC; Victoria Lee, MD, MPH, MBA, CCFP FRCPC, Surrey, BC; Kendall Ho, MD, FRCPC, Vancouver, BC; Arun Garg, MD, PhD, FRCPC ,FACP, FASCP, Surrey, BC; Gary Thandi, MSW, RSW, Surrey, BC

705 MTCC

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Context: Ethnic minorities are less likely to access clinical prevention services , but there is limited evidence about how to facilitate uptake for these populations. Objective: The purpose of this study was to examine the barriers and facilitators to clinical prevention uptake for the South Asian population in Surrey and to identify effective methods to increase the use of services. Design: The study used an inductive, qualitative design based on a series of focus groups with members of the South Asian community. Transcripts were analyzed using thematic data coding and responses were compared based on clinical prevention topic area and group characteristics. Participants: A total of 62 adults between the ages of 40 and 80 participated in 1 of 8 focus groups in health care and community settings. Instrument: The focus group guide for the study covered a total of 10 priority clinical prevention topics and each group discussed 3 of these topics. In order to facilitate open discussion participants were asked to respond to questions based on a scenario about a fictitious person who learns about a clinical prevention topic and then chooses not to access it. Participants also completed a brief demographic interview. Findings: The findings from this study can be classified into 3 levels of recommended changes. At the micro level, themes included barriers to effective communication with care providers and logistical concerns. At the meso level, participants suggested exploring different delivery models and locations for services. At the macro level the discussion focused on the creation of stronger policies in the interest of the public good. Conclusion: Based on these findings we concluded that barriers to culturally accessible and acceptable care occur at multiple levels of the health system. These findings can be used to inform how existing and emerging programs, educational materials and services can be tailored to meet the values and needs of South Asians in order to increase the uptake of clinical prevention services for this population.

Potentially Avoidable Emergency Department Visits for Family Practice Sensitive Conditions Michelle Martin-Rhee, PhD, Program Lead, CIHI, Toronto, ON; Cheryl Gula, Toronto, ON

707 MTCC

Description: Context: Canadians visit the emergency department (ED) frequently, at times for minor medical problems that might be more appropriately treated elsewhere. Many jurisdictions are evaluating strategies to reduce avoidable ED visits, and identifying and quantifying these visits can help efforts to improve appropriateness of care. Objective: This study from the Canadian Institute for Health Information (CIHI) examines ED utilization to identify visits that might be more appropriately managed at a family physician’s office or clinic, known as family practice sensitive conditions (FPSCs). Design: ED visits for primarily low acuity reasons where patients were not admitted to inpatient beds were calculated and compared to rates of visits for other reasons. Possible explanatory factors including diagnosis and acuity, time of visit, length of stay, and patient age, SES, and rurality were examined. Target population: Included in the analysis are all unscheduled visits to EDs (excluding urgent care centres) in 2013–2014 where patients were discharged home. Instrument: This study uses data from CIHI’s National Ambulatory Care Reporting System (NACRS). The following jurisdictions submitted ED data with complete ICD-10-CA diagnoses in 2013–2014 and are included in the results: Ontario (all facilities); Alberta (all facilities); Nova Scotia (5 facilities); Saskatchewan (4 facilities); PEI (1 facility); and Yukon (1 facility).

Results: Overall, 1 in 5 non-admitted ED visits were for FPSCs, totaling more than 1.4 million visits in 2013–2014. The most common reasons for these visits included upper respiratory infections (13%), antibiotic therapies (13%), sore throats (8%), ear infections (7%), and care following surgery such as dressing changes and removal of stitches (5%). More than one-third (35%) of non-admitted visits for children younger than age age were for FPSCs, compared with only 12% for patients age 85 and older. Additionally, 32% of nonadmitted ED visits among rural-dwelling patients were for FPSCs, versus 17% among urban-dwelling patients. Conclusions: Providing care for patients presenting with FPSCs in settings such as doctors’ offices and clinics might improve continuity of care and the patient experience, and allow ED resources to be focused on those who more appropriately require them.

W107800 Case Management In Primary Care for Frequent Users: A qualitative study of patients’ and family 16:00–16:15 physicians’ experience Catherine Hudon, MD, PhD, CCMF, Sherbrooke, QC; Maud-Christine Chouinard RN, PhD; Fatoumata Diadiou, MA; Danielle Bouliane MA(c); Mireille Lambert, MA

706 MTCC Description: Context: Although case management (CM) is increasingly implemented to address the complex needs of vulnerable clienteles, few studies have examined patients' and family physicians' (FPs') experience. The aim of this study was to examine the experience of people with chronic diseases, frequent users of health care services, and FPs who participated in a CM intervention. Design: A descriptive qualitative approach. Setting: Four family medicine groups in the Saguenay region, Quebec, Canada. Participants (n = 45): People with chronic diseases (n = 25), frequent users of health care services and FPs (n = 20) who participated in a CM intervention by a nurse in primary care. Methods: Data were collected through in-depth interviews (frequent users) and four focus groups (FPs). Thematic analysis of the verbatim transcripts used the six dimensions of services' integration proposed by the National Collaboration for Integrated Care and Support: 1) consideration of patient and family needs; 2) communication with the patient and between providers; 3) access to information; 4) involvement in decision making; 5) care planning; and 6) transitions between various health professionals. Results: Patients confirmed that the CM nurse was usually their privileged contact with primary care. S/ he actively involved them in developing and carrying out their individualized services plan with other health care partners. Patients and FPs felt that patients’ needs were taken into consideration. They considered that the case manager facilitated communication and coordination with and among health care partners as well as better access to relevant information, but a few patients and FPs

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE had not fully understood case management at the beginning of the intervention. Some FPs would have wished to have had more interactions with the case manager. A few people considered that this implies too many appointments. Patients and FPs agreed on the fact that patients were actively involved in decision making. The individualized services plan was considered helpful to improve transitions between services.

Conclusions: The experience of people with chronic diseases, frequent users of health care services, and FPs who participated in a CM intervention in primary care was, overall, positive, regarding care integration.

W108046 16:00–16:15

Developmental Outcomes of Children Born to Methadone-Maintained Mothers: Implications for primary care providers

Alice Ordean, MD, CCFP, MHSc, FCFP, ABAM Dip, Toronto, ON; Lauren Self, MD,, CCFP, Toronto, ON; Kare Querengesser, MD, CCFP, Toronto, ON; Brian C. Chisamore, MD, MHSc, FRCPC, FAAP, Toronto, ON

704 MTCC

Description: Context: Perinatal opioid use is highly prevalent in primary care and has been linked to adverse neonatal outcomes. Therefore, integrated care including methadone maintenance treatment (MMT) is the standard of care for the management of opioid use disorders during pregnancy.

The most significant complication of perinatal MMT is neonatal abstinence syndrome (NAS) . NAS is an acute time-limited consequence of MMT and has been extensively studied. However, long-term developmental outcomes of children with in utero methadone exposure are not well known. Objective: To describe developmental outcomes of a Canadian cohort of children with antenatal methadone exposure. Design: Retrospective chart review Participants: Opioid-dependent pregnant women who attended an integrated primary-care based program and their infants who were born between 2009 and 2011 and followed over 2 years at the Neonatal Follow Up Clinic at St. Joseph’s Health Centre were included in this study. Outcome Measures: Maternal and neonatal demographics, developmental outcomes Results: Twenty-three maternal-newborn dyads met inclusion criteria. The majority of mothers had a history of prescription opioid use disorder requiring MMT. The mean birth parameters were as follows: birth weight 2881g, length 49cm and head circumference 34cm. Almost half of these neonates were in part breastfed and 87% were discharged home in the care of a biological parent. Fourteen of these children attended for developmental assessments with nine lost to follow-up. The overall prevalence of gross motor abnormalities was 36.3% before 12 months and decreased to 12.5% thereafter. Fine motor and communication delays were observed after one year of age in 25% and 37.5% of infants, respectively.

Abnormal social development was rare. Conclusions: Our study demonstrated that gross motor delays seemed to resolve after one year of age while communication and fine motor delays becoming more prevalent on subsequent assessments. These results also emphasize the importance of early screening and intervention programs for this vulnerable population. Primary care providers play a critical role in supporting families with parental subtance use disorders to optimize the environment in which these children are raised and to positively influence their development.

W108070 Cervical Cancer Screening and HPV Vaccine Uptake Among Immigrant Women Versus 16:00–16:15 Canadian-Born Women Omolayo Famuyide, MD, BScPharm, Vancouver, BC; Ellen Wiebe, MD, CCFP, FCFP, Vancouver, BC; Gina Ogilvie, MD, MSc, FCFP, DrPH, Vancouver, BC

705 MTCC Description: Context: Cervical cancer screening (CCS) and human papillomavirus (HPV) vaccines are used to prevent disease caused by HPV. Objective: The primary objective of this study was to compare CCS between immigrant versus Canadian-born women. Secondary outcomes included comparing knowledge, attitudes, and HPV vaccination in the two groups. We also assessed the predictors of screening. Design: This was a quantitative study using questionnaires to ask women about their demographics, sexual history, screening history (defined as a Pap test within three years), and HPV vaccination, as well as their perceptions about screening and the HPV vaccine. Data collected from the questionnaires were entered into SPSS Statistics software for analysis. Participants: Consecutive women presenting for medical abortion between September 2014 and February 2015 were offered questionnaires. Results: There were 446/600 completed questionnaires (74.3%); 223 (50%) were Canadian-born women and 222 were immigrant women. There were 184 Canadian-born women (87.6%) compared to 134 immigrant women (66.3%) who participated in the CCS program (P = <.001). There were 103 immigrant women who were not considered low risk (more than one sexual partner). In univariate analyses, predictors of having a Pap were age, having heard of HPV, years in Canada, age of sexual debut, and number of sexual partners. In logistic regression analyses, older age (AOR 1.1; 95% CI 1.0 to 1.2), more sexual partners (AOR 1.224; 95% CI 1.0 to 1.5), and more years in Canada (AOR 1.1; 95% CI 1.0 to 1.2) were factors predictive of having a Pap smear.

HPV vaccine rates among both groups were low, with only 44 out of 223 (21.1%) of Canadian-born women and 23 out of 222 (12.0%) of immigrant women having had the HPV vaccine (P = 0.47). Conclusions: Our study found that cervical cancer screening rates are lower in immigrant women versus Canadian-born women. The women at greatest risk of HPV, that is, older women with more sexual partners, were more likely to be screened. The rates of screening and vaccination are still too low and this implies that we need to continue to work on continued establishment of effective programming and education that will help to address knowledge perceptions.

W101610 Socioeconomic Status and Risk of Hemorrhage During Warfarin Therapy for Atrial Fibrillation: 16:15–16:30 A population-based cohort study Alex Cressman, MSc, MD (C), Toronto, ON; Erin M. Macdonald, MSc, Toronto, ON; Zhan Yao, MSc, Toronto, ON; Peter C. Austin, PhD, Toronto, ON; Tara Gomes, MHSc, Toronto, ON; Michael Paterson, MSc, Toronto, ON; Moira K. Kapral, MD, MSc, Toronto, ON; Gina Ogilvie, MD, MSc, FCFP, DrPH, Vancouver, BC; Muhammad M. Mamdani, PharmD, MPH, Toronto, ON; David N. Juurlink, MD, PhD, Toronto, ON

705 MTCC

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Description: Context: Among patients taking warfarin, lower socioeconomic status is associated with poorer control of anticoagulation. However, the extent to which socioeconomic status influences the risk of hemorrhage is unknown. Objective: To examine the extent to which socioeconomic status influences the risk of hemorrhage in older individuals newly commencing warfarin therapy for atrial fibrillation.

Design: Population-based cohort study using health care administrative data. Participants: Patients aged 66 years or older with atrial fibrillation who commenced warfarin therapy between April 1, 1997, and November 30, 2011, in Ontario, Canada. Validated ICD-9 and ICD-10 codes were used to identify a diagnosis of atrial fibrillation. We used neighbourhood-level income quintiles as a measure of socioeconomic status. Outcome measures: The primary outcome was an emergency department visit or hospitalization for hemorrhage and the secondary outcome was fatal hemorrhage. Validated ICD-9 and ICD-10 codes were used to identify a diagnosis of hemorrhage. Results: We studied 166 742 older patients with atrial fibrillation who newly commenced warfarin therapy. Of these, 16 371 (9.8%) were hospitalized for hemorrhage during a median follow-up of 369 (interquartile range 102 to 865) days. After extensive multivariable adjustment using Cox proportional hazards regression, we found that those in the lowest income quintile faced an increased risk of hospitalization for hemorrhage relative to those in the highest income quintile (adjusted hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.12 to 1.23). Similarly, the risk of fatal hemorrhage (n = 1802) was increased in the lowest relative to the highest income quintile (adjusted HR 1.28; 95% CI 1.11 to 1.48). Conclusions: Among older individuals receiving warfarin therapy for atrial fibrillation, lower socioeconomic status is a risk factor for hemorrhage and hemorrhage-related mortality.

This factor should be carefully considered by clinicians when initiating and monitoring warfarin therapy.

W107284 Polypharmacy and Chronic Disease Surrogate Markers in Nursing Home Patients: A cross-sectional 16:15–16:30 survey

Rita McCracken, MD, CCFP, Vancouver, BC; Charmaine Lam, medical student, Vancouver, BC; Jonathan Berkowitz, PhD, Vancouver, BC; Scott Garrison, MD, FCPC, PhD, Edmonton, AB

704 MTCC Description: Context: Polypharmacy is a recognized source of harm for frail elders, yet many experimental approaches to try to reduce the numbers of medications in nursing homes have failed. Some studies suggest that a focus on disease management, rather than on frailty-appropriate treatments, might be contributing to polypharmacy. A provincial pharmacy data analysis published in September 2014 suggested that prescribing continues to rise for elders in nursing homes. Objective: 1) Describe prevalence of polypharmacy for a representative group of frail elders in nursing homes in British Columbia and their associated patient characteristics. 2) Determine if there are potential associations between hypertension and diabetes surrogate markers and numbers of medications prescribed.

Design: Cross-sectional survey. Participants: Two hundred and thirteen randomly selected nursing home patients from six nursing homes in BC’s lower mainland with a total population of 950 patients and with a highly regarded physician and pharmacist care model in British Columbia’s lower mainland. Intervention: Patient data collated from pharmacy database, patient chart, and local administrative database. Main outcome measures: Mean number medications prescribed, systolic blood pressure (SBP), hospital visits for each patient, and demographic characteristics. Results: The mean number of medications prescribed was 7.5 ± 3.4. Among the patients in the study, 70.4% had a diagnosis of hypertension and 100% had a measured SBP, mean 126 ± 18 mmHg. Only 27% had a diagnosis of diabetes, mean HgbA1c 6.5 ± 1.19. The average number of hospital visits in the preceding year for each patient was 0.7 ± 1.5. A diagnosis of hypertension was associated with more medications (P = .04) and increasing age was associated with fewer (P = .002). No association was found between number of medications and a diagnosis of diabetes or dementia, nor with length of stay, prescribing MD, or number of hospital visits. Conclusions: The number of medications prescribed to frail elders remains high.

Chronic disease treatment might be contributing to this large number. In the case of hypertension, the mean systolic blood pressure was surprisingly low and relaxation of surrogate targets might result in fewer medications. Future efforts to address polypharmacy might have more success if they directly address appropriate drug therapy for frail elders with chronic diseases.

W108416 16:15–16:30

Case Finding and Managing COPD Cathy Faulds, MD, CCFP, FCFP, London, ON

704 MTCC

Learning Objectives: 1. build a chronic disease program with quality improvement and evidence-based guidelines 2. prevent patients from becoming the top 5% of system users 3. follow COPD patients through the system and measure their journey of Canada, new committees and staff, this is a good time to have a warm conversation sharing our hopes for family medicine teaching, scholarship and research.

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE W122373 16:00–17:00

Fireside Chat with Section of Teachers Council Chair, Dr. Ian Scott Ian M. Scott, MD, CCFP, FCFP, Vancouver, BC

714B MTCC

Description: Join us to wrap up the Family Medicine Innovations in Research and Education Day with an opportunity to share your reflections about the day and provide suggestions for future directions. With the organizational changes occurring within the College of Family Physicians.

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Cancer Diagnosis and Treatment Time Intervals: Urban and rural differences in Ontario, Canada

Andriana Barisic, MPH, Toronto, ON; Eva Grunfeld, MD, DPhil, CCFP, FCFP, Toronto, ON; Julie Gilbert, PhD, Toronto, ON

Description: Context: Despite evidence demonstrating differences in cancer survival between provinces, and between regions within Ontario, the reasons for these differences are not fully understood. Previous research has suggested that diagnostic/treatment delay might be a contributing factor; however, little is known about geographic differences in diagnostic/treatment delay, especially in the Canadian context. Objective: To examine urban/rural differences in the time intervals between the onset of first symptom(s) to cancer diagnosis and treatment. Design: This work was part of the International Cancer Benchmarking Partnership (ICBP), an international collaboration involving nine countries. It is comprised of five separate areas of research (modules), each examining reasons for observed differences in cancer survival. The focus of this research is Module 4, which was a cross-sectional survey that examined the underlying causes of cancer diagnostic and treatment delay. Participants: In Ontario, adults aged 40 years and older diagnosed with breast, colorectal, lung, or ovarian cancers were identified through the population-based cancer registry. Eligible individuals were first contacted by Cancer Care Ontario for consent to be contacted by ICBP research staff. Those who consented were mailed a survey between May 2014 and October 2015. Instrument: The survey examined the pathway to diagnosis (eg, screening, emergency department, or primary care presentation); patient, diagnostic, and treatment time intervals; perceived health status; treatments for comorbidities; and sociodemographic factors. Outcome measures: The primary outcome is the patient (onset of symptom[s] to presentation to health care provider [HCP]), diagnosis (presentation to HCP to cancer diagnosis), treatment (cancer diagnosis to start of treatment), and total (onset of symptom[s] to start of treatment) time intervals. The predictor variable is urban/rural status (defined using the 2011 Canadian Census). Results: Recruitment will be completed by October 2015. To date, 2510 individuals have consented (breast [n = 1205]; colorectal [n = 745]; lung [n = 475]; ovary [n = 85]), of which 88.5% have returned a completed survey (breast [n = 1091]; colorectal [n = 634]; lung [n = 402]; ovary [n = 79]). Differences in the patient/diagnostic/treatment time intervals by urban/rural status, by pathway to diagnosis, and by cancer type will be presented. Conclusions: The results will inform Cancer Care Ontario’s strategy to improve the diagnosis/treatment time intervals, thereby potentially improving cancer survival.

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POSTER PRESENTATIONS / PRÉSENTATIONS D'AFFICHES NOVEMBER 11 NOVEMBRE – 716AB MTCC

Factors Influencing Colorectal Cancer Screening Five Years After an Educational Intervention

June Carroll, MD, CCFP, FCFP, Toronto, ON; Joanne Permaul, BSc (Hons), MA, CCRP, Toronto, ON; Kara Semotiuk, MS, (C)CGC, Toronto, ON; Ellen Warner, MD, MSc, FRCPC, FACP, Toronto, ON; Elizabeth Dicks, PhD, St. John's, NL;Sean Blaine, MD, Stratford, ON; Mary Jane Esplen, PhD, RN, Toronto, ON; Heidi Rothenmund, MSc, (C)CGC, Winnipeg, MB; John McLaughlin, PhD, Toronto, ON

Description: Context: Screening for colorectal cancer (CRC) decreases mortality yet screening is suboptimal. In Phase 1, we demonstrated that a CRC risk assessment/management point-of-care tool for family physicians (FPs) significantly increased confidence in CRC risk assessment/management for CRC patient vignettes. The patient booklet significantly increased knowledge. Objective: To determine the self-reported CRC screening practices of these same FPs and their participating patients five years following the intervention (Phase 2) and the factors influencing screening. Design: Self-complete surveys. Participants: In Phase 1, a random sample of 75 Ontario and Newfoundland FPs participated in the educational intervention and recruited the next five patients with CRC family history (FH). Phase 2 includes those who agreed to re-contact. Intervention: CRC risk-assessment/management tool for FPs and patient booklet. Outcome measure: Correct self-reported CRC screening. Results: Forty-nine of 63 (78%) FPs who agreed to re-contact (mean age = 45, 41% female) and 171 of 236 (72%) of their patients (mean age = 54, 75% female) participated. Of these patients, 4% were high risk of CRC; 29% were moderate; 56% were low; and 12% were population risk (assessed from patientcompleted FH). Patient-reported CRC screening with the “correct” test increased from 72% to 76% (NS) from Phase 1 to 2, with FP's recommending of screening since Phase 1 being the strongest predictor of correct screening (OR 3.0, 95% CI 1.2 to 7.2). Sixty-nine per cent of patients reported discussing CRC FH with their FP since Phase 1, with the majority (83%) saying they initiated it. Correct patient self-assessment of CRC risk dropped from 55% to 39% (P = .002), with the majority underestimating. Those underestimating risk were significantly less likely to have the “correct” test but this did not remain significant in the logistic regression analysis. Patient knowledge (score ≥ 8/15) significantly increased (44% to 65%, P < .001). Among the FPs, 96% reported routinely asking cancer FH, and 60% of FPs continued to use the CRC tool. Discussion/conclusion: Recommendation from their FP was the strongest predictor of “correct” CRC screening in those patients with a CRC FH who had higher self-reported CRC screening than is generally reported in Canada (25% to 30%). Findings suggest educational efforts directed at patients might increase screening. The tendency for patients to underestimate CRC risk reinforces the FP role in recommending screening.

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Early Integration of Palliative Care in Primary Care: INTEGRATE Project

Sandy Buchman, MD, CCFP, FCFP, Toronto, ON; Marnie MacKinnon, BPE, Toronto, ON; Hardeep Johal, PMP, BSc, Toronto, ON; Erin Arthurs, MSc, Toronto, ON; Tara Walton, MPH, BSc, Toronto, ON

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Description: Objective: The goal of the INTEGRATE Project is to identify and manage patients to benefit from a palliative care approach early and across health care settings. Objectives of the INTEGRATE Project are to adapt and disseminate educational resources to build the capacity of primary care providers to identify, link, and deliver palliative care in communities; and to test integrated models in the primary care setting to enable providers to take ownership for early identification and management of patients who would benefit from a palliative approach.

Method: Four primary care practices (three family health teams and one family health group) will identify patients that might benefit from early identification using the Surprise Question “Would you be surprised if this person died in the next 6 to 12 months?” and then initiate a palliative care approach with an interdisciplinary team. Implementation will focus on a quality improvement (QI) approach at select sites and then on evaluating what is scalable at a provincial level. This session is relevant for clinicians, residents, students, administrators, and researchers. The material will be presented through an interactive presentation. Results: The provider education component of the project will measure changes in knowledge, attitude, and behaviour of primary care providers before and after completion of the education. The integrated model in primary care assesses current practice and perception of palliative care through a baseline survey, which will be repeated mid- and post-implementation to evaluate change over time. The process of identifying patients within the practice and their health care utilization patterns will be measured for the duration of the project. Results from the provider education activities and baseline survey will be available for the conference. Early results on the identification of patients in the participating practices will also be available. Conclusion: This project has the potential for significant impact on organizational and health system design for patients and their families who will benefit from earlier identification of palliative care in the primary care setting. The results of evaluation will translate into provincial recommendations for Ontario.

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Comprehensive Video-Module Instruction as an Alternative for Teaching IUD Insertion Juan Garcia-Rodriguez, MD, CCFP, MSc (Med Edu), Dip Sports Med, Calgary, AB; Tyrone Donnon, BSc, BEd, MEd, PhD, Calgary, AB

Description: Context: IUD insertion has been traditionally taught at scheduled training sessions or during rotation at contraception teaching clinics.

The limited number of skilled faculty who can teach procedural skills, and issues of time and access, have made it difficult for residents to learn this procedure. Objective: To determine how effective the use of video-module instruction is as an alternative procedural skill– teaching method to deliver IUD insertion training for family medicine residents. Design: This randomized, two-group (n = 39) pre-/post-test (written) experimental research design focused on the comparison of residents’ post-test performances based on the traditional instructional (designated site demonstration) and video-module approaches to teaching the IUD insertion procedure. Participants: Incoming 2012 firstyear family medicine residents (n = 39), 53.8% (n = 21) of whom were males and 46.2% (n = 18) of whom were females. Exclusion criteria: Previous IUD insertion during clinical training or previous medical practice that involved IUD insertion (eg, international medical graduates).

Intervention: Exposure to traditional instruction or video-module approaches to teaching the IUD insertion procedure. Outcome measures: Assessment of knowledge and performance of the procedure. Results: Although the traditional and intervention instructional groups improved significantly in their clinical knowledge scores from pre- to post-test, there was found to be no difference between the groups on the written exams. On the post-test IUD insertion performance assessment, residents in the video-module intervention group performed significantly better than the traditional instructional group (P < .05, mean effect size difference Cohen’s d = 0.75). The internal reliability (Cronbach alpha) of the 27-item performance checklist was α = 0.77. Conclusion: Both the traditional and video-module instructional methods were found to be reliable and valid approaches for the teaching and learning of the IUD insertion procedure. The results provide support for the use of a video-module teaching session as a potential method to supplement or enhance IUD insertion procedural skill training. The ability to access this method of instruction online makes this approach highly feasible for residents. In addition, the performance assessment and patient interview checklists that were developed as part of the video-module instructional method might prove to be useful to guide and evaluate the IUD insertion procedures with actual patients.

505 We Need Something BETTER: Patients’ perspectives on a novel approach to chronic disease prevention and screening

Donna Manca, MD, MClSc, FCFP, Edmonton, AB; Nicolette Sopcak, PhD, Edmonton, AB; Candace Nykiforuk, PhD, Edmonton, AB; Carolina Aguilar, MA, MSc, Edmonton, AB; Mary Ann O'Brien, PhD, Toronto, ON; Kris Aubrey-Bassler, MD, MSc, CCFP (EM), St Johns, NL; Richard Cullen, BSc, St. John’s, NL; Melanie Heatherington, MEd, Edmonton, AB; Eva Grunfeld, MD, DPhil, FCFP, Toronto, ON

Description: Context: BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a chronic disease prevention and screening (CDPS) program that has been implemented in various primary care settings in Newfoundland and Labrador. The program aims to improve CDPS for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65 years.

The key component of BETTER is the prevention practitioner (PP)—a health care professional with specialized skills in CDPS who structures and complements physicians’ CDPS practices in the primary care setting. Some physicians involved in BETTER were skeptical of the benefits of having a PP. Objective: To explore patients’ perspectives on their visit(s) with a PP in three primary care settings in Newfoundland and Labrador. Methods: Of 154 patients who received one or more prevention visit(s) with a PP, 90 volunteered to provide written feedback.

Besides their demographics, patients were asked what they liked about their visit(s), what they would have liked to have been different about their visit(s), and to provide other comments. We employed qualitative description to analyze the data. Findings: We identified four main themes regarding patients’ perspectives on their visit(s) with a PP: 1) Value of visit: All 90 patients who provided feedback unanimously reported their visit with a PP to be positive and appreciated having a PP as part of the health care team. 2) Visit characteristic: Patients valued the focus on health (as opposed to disease) and that the visit was personalized, comprehensive, and motivating. 3) PP characteristics: The patients saw their PP as key to their positive experience with the program. Patients characterized the PPs to be compassionate, attentive, thorough, knowledgeable, motivating, and supportive. 4) Access concerns: Patients perceived their prior access to preventative care to be limited and expressed concerns about the termination of the program. Conclusion: Patients’ views that a PP should be an available resource within primary care settings were a contrast to the perception of some physicians involved in BETTER. Our findings may help inform stakeholders in primary care settings as they consider implementing programs to enhance their current CDPS practices.

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Sandra Rees, BScPharm, Edmonton, AB; Sudha Koppula, BSc (Hons), MD, MClSc, CCFP, Edmonton, AB

Description: Background: Patients and front-line clinicians are traditionally not included in decisions around research priorities. There is increasing focus on engaging patients in the health research process to ensure research undertaken is patient-oriented. The James Lind Alliance (JLA) has developed a process for engaging patients and clinicians in the research priority-setting process. We employed the JLA process to determine research priorities in gestational diabetes in Alberta. Methods: A steering committee was established, with equal representation of patients and clinicians, to guide the process. A survey was developed and administered across Alberta, in various formats over four months. Survey submissions were organized into categories. Management uncertainties were identified from clinical practice guidelines. Steering committee members (in patient-clinician pairs) reviewed the submissions and developed summary questions for submissions in a similar theme. The steering committee individually ranked the list of indicative questions, identifying the top 30 uncertainties. The steering committee reviewed all of the individual rankings and came to consensus on a list of 29 research priorities for a priority-setting workshop, with an equal number of patients and clinicians, who identified the top 10 research priorities, using a nominal group format. Results: Across the survey formats, 75 individuals submitted 389 uncertainties. The majority [44 (59%)] of submissions came from patients. We removed 9 questions as either out of scope or unclear. An additional 41 uncertainties were identified on a review of clinical practice guidelines, resulting in a total of 421 research uncertainties. From these, the steering committee developed 48 summary questions, plus 26 unique questions, for a total of 74 research uncertainties. These were then pared to the top 29 uncertainties, which were considered at the workshop. The facilitated workshop had 15 participants (8 patients, 3 physicians, 3 nurses, and 1 dietitian). The top 10 research uncertainties were then chosen. Conclusions: Through a comprehensive process involving equal representation from patients and clinicians, a list of 10 research priorities that are important to women who have experienced gestational diabetes and the clinicians that treat them were determined. These priorities will be disseminated to funding agencies, researchers, and the provincial health delivery organization.

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506 Engaging Patients and Clinicians in Establishing Research Priorities for Gestational Diabetes in Alberta Using the James Lind Alliance Priority-Setting Process

Using Mobile Applications for Knowledge Dissemination in Cataract Surgery Patients Harry Dang, BSc, MD (Cand), Markham, ON

Description: Objective: To assess the effectiveness of the iOphthalmology mobile application in enhancing patients’ knowledge and satisfaction of cataract surgery at the Kensington Eye Institute, a high-volume Canadian cataract centre. Design: Cross-sectional study. Participants: Seventy-seven patients who were undergoing cataract surgery at the Kensington Eye Institute for the first time with no previous ocular pathology. Intervention: To improve patient knowledge on surgical procedures, we developed the iOphthalmology mobile application in Toronto, Ontario, in 2014. This application is currently available for no cost on the Google Play digital distribution platform in Android devices, including smartphones and tablets. This application was used by cataract surgery patients with the goal of increasing patient knowledge of cataract surgery and increasing patient satisfaction. Outcome measures: Following patient consent, we administered a questionnaire to assess the following: knowledge of cataract surgery, perceived outcome of surgery, decisional conflict level, uncertainty level, sex, occupation, age, highest education level, Ontario Health Insurance Plan status, and literacy status. After using the application, we measured the overall satisfaction by all patients. Results: Both decisional conflict scores and cataract surgery knowledge scores significantly improved after using the application (mean difference +7.1, P = .02 and +3.4, P < .01, respectively). Multiple regression analysis revealed being illiterate, decisional conflict level, and female sex to be critical factors in the degree to which the application increased patients’ knowledge on cataract surgery (β = 3.1, P < .003 for literacy level, β = 2.0, P = .01 for decisional conflict, and β = -0.9, P < .01 for female sex). Seventy-one of 77 (92.2%) patients were satisfied with the mobile application. Patient satisfaction score was significantly correlated with the overall change in patients’ knowledge of cataract surgery score (correlation coefficient: 0.31, P = .01). Conclusions: The iOphthalmology mobile application for Android devices is effective in enhancing patients' knowledge regarding cataract surgery, and in decreasing their anxiety in their decision to proceed with cataract extraction surgery. This open-source mobile application can potentially benefit patients who might have restricted access to health care, including patients in countries with low literacy rates. The use of this application prior to cataract surgery can help to alleviate the worldwide burden of cataract blindness.

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A Meta-analysis of the Efficacy of Procedures for the Management of Open Angle Glaucoma Harry Dang, BSc, MD Candidate, Markham, ON

Description: Objective: To compare the efficacy of surgical procedures for the management of open angle glaucoma (OAG). Design: Metaanalysis. Literature searches of EMBASE, Pubmed, MEDLINE, and the Cochrane Library were conducted up to June 2014 with no data or language restrictions. Randomized trials involving trabeculectomy and one or more of the following procedures were eligible for inclusion: viscocanalostomy, deep sclerectomy, and canaloplasty. Participants: B/A Intervention: N/A. Outcome measures: The primary endpoint of this study was the mean difference between procedures in the reduction of intraocular pressure (IOP) preoperatively to 6-months postoperatively. Results: Of the 196 retrieved citations, 14 were considered topically relevant, for a total of 18 comparisons (9 trabeculectomy vs. deep sclerotomy; 1 trabeculetomy vs. canaloplasty; 8 trabeculectomy vs. viscocanalostomy) in 790 eyes from 681 patients. Of the four procedures, trabeculectomy had the best IOP-reducing effect (mean difference of -2.32, 95% CI: -3.11 – 1.54, attached figure). Subgroup analysis revealed no heterogeneity (I2=0). Conclusions: Overall, trabeculectomy was the most effective procedure in lower IOP in open angle glaucoma patients.

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE 509 Evaluation of Chronic Hepatitis B Management and Monitoring Among Asian Immigrants: A practice-reflective project

James Leung, MD, CCFP, FCFP, Toronto, ON; Andrea Leung, MD (Cand),Toronto, ON; Stephen Lau, Toronto, ON; Simon Cheung, BSc (Hons), Toronto, ON

Description: Introduction: In Canada, chronic hepatitis B infection is largely a disease of immigrants from endemic countries, with approximately 600 000 cases, based on 6% rate in immigrants. Among untreated chronic hepatitis B patients, 20% to 25% can progress into cirrhosis, chronic liver failure, and hepatocellular carcinoma. Objective: To evaluate chronic hepatitis B management and monitoring in primary care practice with a high prevalence of cases from Asian immigrants. The project identified HBsAg–positive patients and assessed the care according to Canadian hepatitis B guidelines for monitoring. Design: Retrospective chart review from a primary care office with predominantly immigrants from Asia. Setting: Toronto. Participants: A total of 2100 patients were screened. We identified 97 (4.6%) patients with HBsAg–positive status. All patients were Asian immigrants. Methods: The study assessed the data from lab results in ALT, HBeAg status, HBV DNA viral load, platelets counts, abdominal ultrasound, and other data for liver cirrhosis assessment. Three groups of patients were assigned. The “red” high-risk group included high-viral-load patients for therapy consideration. The “yellow” missing-lab-results group included patients missing at least one of the results;the "green" group was the low-viral-load group. Results: Among these 97 patients with hepatitis B, 33.0% of the patients were in the “red” high-viral-load group, with only 11.3% under treatment for hepatitis B, and 51.5% of the patients were in the “yellow” missinglab-results group, missing one of HBeAg, HBV DNA, ALT, or platelet results; 42.3% of patients were not undergoing regular abdominal ultrasound, with more than 12 months' interval. Only 23.7% of patients were in the “green” low-viral-load group. Conclusion: This project has identified that a significant care gap exists in chronic hepatitis B monitoring. The Canadian hepatitis B consensus guidelines (2012) recommend close regular monitoring for chronic hepatitis B. More resources for hepatitis B care from federal and provincial governments should be given, due to the expected increase of hepatitis B from immigrants. As with treating other chronic diseases, primary care physicians should have more support to establish a vigilant monitoring system for chronic hepatitis B to reduce the rates of cirrhosis and liver cancer in future.

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Web-Based Intervention for Chronic Back Pain

Shashank Garg, MD, CCFP, Calgary, AB ; Divya Garg, MD, CCFP, Calgary, AB; Faruq Chowdhury, MD, Calgary, AB; Gary Barron, MSc, Calgary, AB; Tanvir Chowdhury Turin, MD, PhD, Calgary, AB

Description: Background: Chronic low back pain is one of the most common presenting complaints to the physician's office. Treatment is often challenging and recovery depends on various factors, often resulting in significant investments of time and resources. This review addresses the question “Which web-based interventions aimed at chronic low back pain are of benefit to patients?” Methods: Randomized controlled trials (RCTs) studying web-based interventions directed at adults with chronic low back pain were included. Retrospective studies, narrative reviews, non-randomized trials, and observational studies were excluded. Electronic databases and bibliographies were searched. Results: Eight unique RCTs were identified (n = 1414). The number of patients randomized in each trial ranged from 51 to 580. Four trials studied online cognitive behaviourial therapy (CBT), two studied moderated discussion through email or chat, and two trials studied other webbased interventions with interactive features. Use of CBT was associated with reduced catastrophization among patients. Mixed results were reported with regards to reduction in pain levels and disability. One study that measured health care utilization reported reduced utilization with the use of moderated email discussion. Conclusions: Limited data are available regarding effective web-based interventions to improve outcomes for patients with chronic low back pain. Eight RCTs with small sample sizes were identified in this review. Online CBT appears to show some promise in terms of reducing catastrophization and improving patient attitudes. Further research in this area with larger-scale studies focusing on appropriate outcomes appears to be a priority.

511 An Open-Label True-to-Life Randomized Controlled Trial for Cough as a Trick Measure to Reduce Pain for Skin Puncture During Intra-Articular Knee Joint Injection

Jeetandera Rathi, Cork, Ireland; Tony Heffernan, MBBCH, MICGP, FFSEM, Cork, Ireland; Maeve Davis, MBBCH, MRCP, MICGP, Cork, Ireland

Description: Context: Intra-articular (IA) knee injections are carried out routinely in primary care for alleviation of symptoms associated with flares of osteoarthritis (OA). Various strategies are used to reduce the discomfort associated with the procedure. Objective: The purpose of this study was to evaluate the effectiveness of the "cough trick" (CT) in reducing perceived pain in patients undergoing routine IA steroid injection for knee OA in a primary care setting. Participants: This true-to-life, open-label, multicentre randomized controlled trial was conducted at three separate family practices in Mallow Primary Health Care Centre (MPHC) in Cork, Ireland, from December 2013 to April 2014.

Patients (>18 years) with radiographic evidence of OA were enrolled. Intervention: Participants were randomized 1:1 according to a randomization table involving study number to one of two groups: the CT intervention group and no CT intervention group. Outcome measures: Difference in the self-administered 100 mm visual analogue score (VAS-100) was employed as the primary outcome measure.

As psychogenic factors associated with chronic musculoskeletal conditions might influence pain scores, participants were asked to fill out Patient Health Questionnaire (PHQ9) and Hospital Anxiety and Depression Scale (HADS) questionnaires prior to the procedure. Results: 21 adults were recruited in this study (11 in the intervention group and 10 in the control group). On average, pain scores were higher in the control group (mean [SD]: 39.40 [18.96]) than in the intervention group (mean [SD]:13.09 [17.47]) and the difference was statistically significant (difference in means [95% CI]: -26.31 (-9.67 to -42.94), P = .004). The difference in means was also clinically significant as it was greater than the minimal clinically important difference of 11 mm. The mean HADS anxiety scores and PHQ9 depression scores were lower in the intervention group, but the differences were not statistically significant (P = .517 and P = .158, respectively). Conclusion: Our study demonstrated that the CT implemented during IA knee steroid injections has proven to be statistically significant in reducing pain associated with the procedure. Discussion: Distraction is a well-known cognitive method of pain reduction through the direction of attention to a nonnoxious stimulus in the immediate environment. CT might be a distraction at the moment of skin puncture.

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Musculoskeletal Disorders (MSDs) Among Medical Students: A study measuring prevalence and awareness

Ahmad Allaf, Riyadh, Saudi Arabia; Hamzah Naji, Riyadh, Saudi Arabia; Baraa AlGhalyini, MD, CCFP, MHSc, Riyadh, Saudi Arabia; Ibrahim Muhssen, Riyadh, Saudi Arabia; Abdullah AlSanaa, Riyadh, Saudi Arabia; Sultan AlSaud, Riyadh, Saudi Arabia;Mohamad Kazimi, Riyadh, Saudi Arabia; Baraa AlGhalyini, MD, CCFP, MHSc, Riyadh, Saudi Arabia

Description: Context: According to some statistics, musculoskeletal disorders (MSDs) account for about 40% of occupational problems, resulting in a loss of workdays and a decrease in productivity. Despite the magnitude of the problem, very few studies have looked into the MSDs affecting medical students. Objective: To study the prevalence of MSDs among medical students, the differences in MSDs encountered at different educational levels (ie, preclinical versus clinical), as well as their impact on their education. Design: A survey-based cross-sectional study. Participants: Our sample size is 250 medical students aged from 18 to 26 years, in both clinical and preclinical years in the city of Riyadh, Saudi Arabia. Instrument: We created a survey adapted from the standardized Nordic questionnaire, which addresses prevalence, severity, impact, and awareness. Findings: Analysis showed results that depict a high prevalence of MSDs in medical students (84.21%). The regions affected most during a 12-month period were the neck and lower back, at 50% each; the shoulders, at 32.5%; and the upper back, at 27.5%. The data showed that most MSDs affecting medical students were usually of mild severity, with the exception of back pain, which was reported mostly to be moderate to severe. Among the students, 52.63% reported not considering ergonomics when studying or working, though 61.64% acknowledged that it was the best way to prevent MSDs. Despite the high prevalence of MSDs, only 13.89% of students met with a physician regarding their MSDs; however; only 11.84% took leaves of absence for more than one day during the past year due to an MSD. Expectedly, medical students reflected high awareness regarding how to treat MSDs, with 48.68% choosing exercise and lifestyle modifications over immobilization and the immediate use of pain relief medication. Conclusion: The results suggest that despite the high level of awareness exhibited by medical students regarding MSDs and preventive measures, the prevalence of such disorders remains high.

This emphasizes the role of family physicians in promoting and encouraging ergonomics and the need for its application. Further studies are needed in other populations for comparison, as well as to investigate the reasons for such findings.

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A Pilot Feasibility Study of a Primary Care and Addiction Medicine Collaborative Care Model, SUN:SHARE

Sheryl Spithoff, MD, CCFP, Toronto, ON; Meldon Kahan, MD, CCFP, FCFP, Toronto, ON; Kate Hardy, MSW, Toronto, ON; Geetha Mukerji, MD, MSc, FRCPC, Toronto, ON; Sarah Clarke, PhD, Toronto, ON; Angela Robertson, Toronto, ON; Laura Pripstein, MD, CCFP, Toronto, ON; Geetha Mukerji, MD, MSc, FRCPC, Toronto, ON; Leslie Molnar, MSW, Toronto, ON; Ashok Krishnamurthy, MD, CCFP, Toronto, ON; Wiplove Lamba, MD, FRCPC, Toronto, ON

Description: Substance use disorders (SUDs) are a major cause of morbidity, mortality, and health care utilization. Few patients are in treatment, largely as a result of poor access to and retention in specialized addiction treatment programs. Primary care might be the solution: outcomes are as good as specialized care, retention is better, and capacity is greater. However, because of a lack of training and support, few primary care providers (PCPs) screen and appropriately care for patients with SUDs. As well, PCPs continue to inappropriately prescribe high doses of opioids, increasing the risk of harms (including addiction) to patients. Although there is substantial evidence that shared-care models between PCPs and addiction physicians are the solution to service and knowledge gaps, this model is rarely used in addiction medicine in Canada. We are conducting a program evaluation of a shared-care addiction medicine pilot, SUN:SHARE. In the intervention, addiction physicians facilitate addiction education sessions, assess patients with SUDs, and have case discussions with PCPs at the community sites. The addiction physicians also provide urgent telephone and email consultations with PCPs. The three participating sites are an inner-city community health centre, an inner-city family health team, and a community family health team affiliated with an academic centre. Our objective is to determine if the PCPs participating in the SUN:SHARE pilot improve their management of SUDs. We will survey PCPs at baseline and at six months to look for reported changes in knowledge and behaviour (counselling, prescribing, and referrals to ancillary services). Additionally, we will conduct patient and provider satisfaction interviews, and track how frequently the phone and email consultation services were used. We will use each site’s EMR to track participating PCPs’ prescribing patterns at baseline, six months, and 12 months. We will look for changes in 1) the number of prescriptions for medications to treat alcohol use disorders (naltrexone, acamprosate, and disulfiram) and opioid use disorders (buprenorphine/naloxone) and in 2) high-dose opioid prescribing (above 200 mg morphine equivalent per day).

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Antipsychotics Use in a Real World Setting in Quebec Between 1998 and 2006

Alain Vanasse, MD, FCMF, Sherbrooke, QC; Lucie Blais, PhD, Montreal, QC; Josiane Courteau, PhD, Sherbrooke, QC; Marie-France Demers, BPharm, Quebec City, QC; Pasquale Roberge, PhD, Sherbrooke, QC; Sylvain Grignon, MD, PhD, Sherbrooke, QC;Marie-Josée Fleury, PhD, Montreal, QC; Alain Lesage, MD, PhD, Montreal, QC; Danielle St-Laurent, MSc, Quebec City, QC; Laurence Nedelec, MD, Sherbrooke, QC; André Delorme, MD, FRCPC, Quebec City, QC; Marc-André Roy, MD, FRCP, MSc, Quebec City, QC

Description: Context: Several studies have shown clinical differences in the evolution of schizophrenia and the response to antipsychotics (AP) according to patients’ age and sex. However, few clinical guidelines take this into account in their pharmacological recommendations. Objective: To describe, in a real-world context, the use of antipsychotics (oral or long-acting injectable) according to patients’ age and sex among those living with schizophrenia. Methods: This is a retrospective cohort study using medical administrative databases available in Quebec. The study cohort consists of all adult patients living in the province of Quebec,

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE diagnosed with schizophrenia, admissible to the public drug insurance plan, and initiating an AP (with a clearance period of one year) between January 1998 and December 2006. Results: A total of 16 225 patients (46.2% women) met the inclusion criteria. The median age at AP initiation differed considerably between women (49 years) and men (38 years). The first claimed AP was mainly prescribed by psychiatrists (women: 56.7%, men: 61.0%, decreasing with age) and general practitioners (women: 30.6%, men: 27.3%, increasing with age). Moreover, 92.3% of women and 89.2% of men received an AP in monotherapy, 77.9% from a second-generation (women: 77.2%, men: 78.5%), with a slight difference in the molecule used between women and men (olanzapine: 42.3% vs 47.9%; risperidone: 45.6% vs 39.3%; quetiapine: 10.6% vs 10.1%; clozapine: 1.5% vs 2.7%). Since long-acting injectable second-generation APs were not available before 2004, only 7.0% of patients in monotherapy used this type of AP (women: 6.7%, men: 7.3%). As many as 11.7% of patients did not pursue their treatment after the first month. Conclusions: This study reveals statistically significant differences according to age and sex regarding AP utilization in a "real-world" setting. Ongoing studies will evaluate if these differences in AP treatment lead to different outcomes.

515 Ambulatory Care Sensitive Avoidable Hospitalizations: Assessing predictive factors in COPD hospital episodes of care

Alain Vanasse, MD, PhD, FCMF, Sherbrooke, QC; Josiane Courteau, PhD, Sherbrooke, QC; Mireille Courteau, MSc, Sherbrooke, QC; Pierre Larivée, MD, Sherbrooke, QC; Shengrui Wang, PhD, Sherbrooke, QC; Jianfei Zhang, PhD (Cand), Sherbrooke, QC;Thomas Poder, PhD, Sherbrooke, QC; Pierre Dagenais, MD, PhD, FRCPC, Sherbrooke, QC; Marie-France Beauchesne, PharmD, Sherbrooke, QC

Description: Introduction: The high rates of “unplanned” hospital admissions are an increasing source of pressure on health system resources. Ambulatory care sensitive conditions (ACSC), such as heart failure, diabetes and chronic obstructive pulmonary disease (COPD), are conditions for which hospitalization could be avoidable with ambulatory care management. The COPD is the main cause of emergency admissions and hospitalizations in Canada, with a mean length of stay of 10 days and one of the highest rates of rehospitalization. The purposes of this project are to develop a predictive model for future readmissions of patients with COPD, based on the analysis of their hospital episode of care (EOC), and to identify factors (or "missed opportunities") that can be modified to reduce the readmission rate. Method: This project is a secondary analysis of hospital data on a cohort of patients hospitalized between April 2012 and March 2013 with a primary diagnosis of COPD (ICM-10 J40-J44, J47). The hospital EOC starts at the patient admission (index admission) and ends at the hospital discharge, passing through temporal succession of treatments. The main outcomes are the time until the next readmission (COPD and all cause), the number of readmissions, and the total number of days in hospital during the year after the index admission. Independent variables will be analyzed following the temporal sequence: 1) status before admission (eg, medical history, comorbidity); 2) status at admission (eg, pulmonary condition); 3) status and care during hospitalisation (eg, pharmacological treatments); and 4) status and prescribed treatments at hospital discharge (eg, respiratory conditions, pharmacological prescription, pulmonary rehabilitation). Data mining algorithms and improved survival analysis with adjusted cox regression will be used to detect sequential patterns of predictive variables of readmission. Anticipated results and conclusion: To our knowledge, introducing sequential patterns of predictive variables on EOC is a new methodological approach to identifying factors of rehospitalization for an ACSC. A validated methodology for COPD could be then transferred to other ACSC such as heart failure and diabetes, and might improve the identification of "missed opportunities" to reduce rehospitalization rates.

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Variations Among Spirometry Interpretation Algorithms: The push towards standardization

Florence Mok, Mississauga, ON; Amy Liao, Toronto, ON; Tony D'Urzo, MD, MSc, CCFP, FCFP, Toronto, ON

Description: Context: Asthma and COPD are two of the most common respiratory illnesses encountered in primary care. Though patients often present with similar symptoms, it is important to distinguish between the two diseases because their pathophysiology and management are very different. Simple spirometry is an objective pulmonary function test that can support a diagnosis of asthma or COPD, but recent evidence has demonstrated that patients with moderate to very severe COPD also meet spirometric criteria for asthma diagnosis. Spirometry interpretation algorithms (SIA) should conform to diagnostic guidelines while acknowledging this overlap and prompting the clinician to consider further clinical assessment where such an overlap exists. Objectives: To determine the variations in SIA that exist in the published literature and online sources. Design: MEDLINE, EMBASE, and mainstream search engines were used to identify all SIA-related material dating back to 1990. Keywords used were “spirometry,” “algorithm,” “algorism,” and “algorhythm.” Results: Seventeen out of 27 SIA are unable to serve well as stand-alone documents. Twenty-four SIA lack a logic string to post-bronchodilator FEV1/FVC ratio, potentially impeding COPD diagnosis.

Ten SIA rely solely on post-bronchodilator improvement to distinguish asthma from COPD. Twenty-three SIA lack a prompt for bronchodilator challenge when FEV1/FVC is normal. Four SIA unnecessarily recommend DLCO testing to confirm COPD diagnosis. Coclusions: Twenty-five out of 27 SIA feature variations might lead to disease misclassification. Further studies are needed to confirm whether this link truly exists.

This study points to the need for minimizing SIA variability, including the need for a standardized approach to the spirometric diagnosis of asthma and COPD. 517 Airway Hyperresponsiveness Among Patients Attending a Primary Care Clinic With Symptoms Compatible With Asthma

Amy Liao, BSc, Toronto, ON; Florence Mok, Mississauga, ON; Anthony D'Urzo, MD, MSc, CCFP, FCFP, Toronto, ON

Description: Context: Asthma is one of the most common chronic inflammatory lung conditions encountered by primary care physicians. Asthma diagnosis is based on clinical symptoms, physical exam findings, simple spirometry, and other objective tests if necessary. Since most patients with mild asthma in primary care have normal lung function, spirometry might lack the sensitivity to provide objective diagnostic confirmation at time of testing—a feature that might delay diagnosis. Furthermore, lack of objective testing has been implicated in over-diagnosis of asthma. While it has been well documented that methacholine challenge testing (MCT) is more sensitive than spirometry for inclusion or exclusion of asthma diagnosis, MCT is promoted as a second-line test in clinical guidelines. The latter might be related to the widespread and timely availability of simple spirometry compared to MCT. Objectives: This study explores airway hyperresponsiveness among patients attending a primary care clinic with symptoms compatible with asthma, using a pragmatic approach that might be suitable for more widespread adoption in the family medicine setting. Design: Retrospective chart review. Participants: Seventy-three patients who attended a primary care clinic with symptoms compatible with asthma, normal spirometry at time of testing, and without a prior diagnosis of asthma were retrospectively reviewed.

Intervention: All patients received timely access to simple spirometry and MCT. Some patients were referred to the clinic by physicians in the local community, including same-day testing. Results: Airway hyperresponsiveness was confirmed in 34.2% of patients (PC20 = 4.1 ± 2.8). fmf.cfpc.ca

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518 Effects of Community-Based Palliative Care on Health Care Utilization in Patients With Advanced Heart Failure

Leah Steinberg, MA, MD, CCFP, Toronto, ON; Meghan White, Toronto, ON; Susanna Mak, MD, PhD, Toronto, ON; Jennifer Arvanitis, MD, CCFP, FCFP, North York, ON; Russell Goldman, MD, MPH, CCFP, FCFP, North York, ON; Amna Husain, MD, MPH, CCFP, Toronto, ON

Description: Introduction: In 2000, patients with advanced heart failure accounted for the second-highest number of hospital days in Canada. The condition is responsible for a high burden of hospitalization for symptoms that are currently difficult to manage in the ambulatory setting, and are associated with high mortality. We propose that providing home-based palliative care (PC) for these patients can meaningfully reduce the number of hospital visits and days in hospital, with the ultimate goal of improving patients' overall satisfaction with care and quality of life. Methods: In a quality improvement (QI) analysis of health care utilization of a sample of patients with advanced heart failure (HF) in a tertiary hospital in an urban setting, we measured and compared the rate of clinic visits, emergency department (ED) visits, hospital admissions, and days in hospital before and after implementing home-based palliative care. Results: A total of 32 patients with HF (69% female, M = 83.6 years of age) were seen in the home-based PC program over a two-year period. In a pre- and post-intervention comparison, meaningful reductions were seen in rates of clinic visits (pre: M = 0.3 visits/month; post: M = 0.1 visits/month), ED visits (pre: M = 1 ED visit/month; post: M = 0.2 ED visits/month), hospital admissions (pre: M = 1.5 admissions/month; post: M = 0.2 visits/month), and days in hospital (pre: M = 12.5 days/month; post: M = 4 days/ month). Median length of stay on the home-based PC program was 2.73 months (range 0.1 to 25.6). Once in the home-based PC program, patients received an average of 2.18 visits/month from a PC physician. Conclusion: Home-based care of patients with advanced heart failure can lead to decreased health care utilization, including a decreased number of clinic visits, ED visits, and hospitalizations. In turn, we hope it can reduce both patient and system burden and result in greater health-related quality of life for patients with advanced heart failure.

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The average turn-around time from time of referral to MCT testing was 21 days. Conclusions: This study shows that about one-third of patients in primary care with symptoms compatible with asthma will exhibit airway hyperreactivity with MCT. This information can be obtained in a timely fashion in the community setting and might be useful for objective confirmation of asthma. Larger studies are required to determine whether our approach might be associated with reductions in asthma over-diagnosis in the primary care setting.

Circadian Rhythms and Cardiovascular Disease: A systematic mixed studies review Justin Gagnon, BSc, MA, Montreal, QC; Michael Cardinal-Aucoin, MSc, PhD, Montreal, QC; Araceli Gonzalez Reyes, BSc, Montreal, QC; Reem El Sherif, BSc, Montreal, QC; Carolyn Arbanas, BSc, MSc, MD, Toronto, ON

Description: Context: Cardiovascular disease (CVD) is the world’s leading cause of death. In Canada, it is estimated that CVD is the cause of over 69 500 deaths annually. Substantial evidence from both animal and human studies now links circadian desynchronization and sleep disturbance with adverse health outcomes, including metabolic and cardiovascular dysfunction. Disruption of the circadian system is also associated with increased incidence and severity of intermediate CVD risk factors such as obesity, diabetes, hypertension, and hyperlipidemia. Given the prevalence of chronic circadian disruption (ie, shift work, electric lighting, and social jet lag), it is crucial to examine current literature pertaining to CVD and circadian disruption, and make a case for their acknowledgement in the primary care setting. Design: We present the results from a systematic mixed studies review incorporating quantitative, qualitative, and mixed methods studies, using both animal models and human subjects. Objective: The purpose of the review is to describe current research linking circadian disruption with CVD and its intermediate risk factors in terms of themes covered, methodology, discipline, intended audience, and the extent to which studies refer to primary care as a potential field of application. Findings: A preliminary literature search suggests a strong, likely causal, link between chronic circadian disruption and CVD. We identified only a small number of articles that discussed the implications of these findings in primary health care. The vast majority of relevant articles we identified were published in basic research (mostly animal studies) and specialist, non-family medicine medical journals. Several papers recommended the potential value of chronopharmacotherapy (drug timing) for CVD treatment, but only a limited number of studies were designed to specifically address the impact of such an approach. Conclusions: Based on preliminary findings, we consider chronic circadian disruption a potential modifiable risk factor for CVD. Our results suggest the need to clearly target the primary health care provider audience regarding the causes and consequences of circadian disruption. We recommend future studies address the effect of the application of circadian concepts in preventative and therapeutic interventions for CVD. 520

The Cardiovascular Health Awareness Program: A pilot project in two family medicine groups in Laval, Quebec

Magali Girard, PhD, Montreal, QC; Marie-Thérèse Lussier, MD, MSc, FMCF, Laval, QC; Janusz Kaczorowski, PhD, Montreal, QC; Emmanuelle Arpin, MSc, Montreal, QC

Description: Introduction: The Cardiovascular Health Awareness Program (CHAP) is a community-based, interdisciplinary, patient-centred cardiometabolic prevention and management program, based on Wagner’s chronic care model, which has been developed and rigorously evaluated in a variety of settings over the last 15 years. However, CHAP has never been implemented and evaluated in Quebec or in interprofessional health care teams such as family medicine groups (FMGs) in Quebec. Objective: To determine the feasibility of integrating in FMGs CHAP health awareness and cardiometabolic diseases management sessions for registered adult patients. Design: A CHAP intervention was pilot-tested in two FMGs in Laval (Quebec) during a six-week period (January to February

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE 2015). Participants: Eight hundred and thirty FMG-registered patients aged 40 years and over received a personalized invitation letter from their physicians to attend a CHAP session. Intervention: During CHAP assessment sessions, participants completed a cardiovascular risk profile form, underwent blood pressure measurement using an automated blood pressure measuring device, received targeted healthy lifestyle and preventive care materials, and were informed about and linked with locally available community resources. Each CHAP session was supervised by a FMG nurse, and staffed by two to four volunteers (peer health educators) recruited by Laval’s Volunteer Bureau and trained by each FMG nurse using standardized protocols developed by the CHAP team and adapted for FMG settings. Results: In total, 18 three-hour sessions were held in two FMGs, attended by 118 FMG-registered patients. The participation rate of 14% was lower than in previous CHAP projects. This can be attributed to the following factors: unseasonably cold weather; having invited younger participants to some sessions; expensive parking at one of the FMGs; and the requirement to confirm patient attendance by phone prior to the CHAP sessions. Results from a focus group with participating volunteers and individual interviews with nurses will be presented, as well as a profile of CHAP attendees.

Conclusion: Results from this pilot project provide insights for a wider implementation of a CHAP intervention in interprofessional health care teams. The project also led to the development of CHAP interventions in other settings, as a result of collaborative work with Laval health authorities.

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Involving Family Physicians in Early Identification of Eating Disorders: A national survey

Ahmed Boachie, MB, ChB, MRCPsych, DCH, FRCPC, FAED, Newmarket, ON; Pierre-Paul Tellier, MD, CCFP, FCFP, Montreal, QC; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON; Karin Jasper, Ph.D. Newmarket , ON; Debra Katzman, MD, FRCPC, FAED Toronto, ON

Description: Context: Children and adolescents with early onset eating disorders, who receive treatment within two years show better outcomes, particularly with family-based treatment. Early identification and treatment may also lower health care costs. Family physicians are in a unique position to identify eating disorders early. The revisions of the DSM 5 endeavour to address the issue. Objective: To understand factors that will assist family physicians in the early identification and management of eating disorders in children and adolescents, specifically to learn family physicians’ current awareness of early warning signs of eating disorders and the extent to which they manage these disorders in their own practices. Design: The study is a survey with multiple-choice questions, requiring 5 minutes of physicians’ time. It has been implemented as a pilot and will be implemented on a national level. Participants: In the pilot, family physicians who referred patients to an eating disorder program were called and asked if they would consider completing the questionnaire. It was faxed to those who agreed. In the National study, all family physicians registered with the College of Family Physicians of Canada will be invited to complete an online version. Results: Pilot study physicians assessed patients between the ages of 12 and 18 over the preceding year. Most common diagnoses were bulimia, anorexia, and avoidant/restrictive food intake disorder (ARFID). Physicians were effective in recognizing classic eating disorder symptoms but most missed the non-specific symptoms characteristic of early onset. All physicians endorsed as either likely or very likely that they would use a screening tool, immediate referral to a specialist service, and a practice-based learning program (PBLP) for eating disorders, if these were available. A PBLP was endorsed as increasing the likelihood that family physicians who do not currently manage these patients in their practices would do so. Conclusions: The pilot study suggests that without further training for family physicians, we will continue to struggle with early identification. A PBLP, an initial screening tool, and immediate referral to a specialist service would be valued by family physicians. The National study will provide greater understanding of these important issues.

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Are Eligible Diabetic Obese Patients Offered Bariatric Surgery as per the 2013 CDA Guidelines?

Hammaan Khan, Oakville, ON; Shahzana Shahzad, Milton, ON; Bilal Khan, London, England; Huma Numair, MD, CCFP, Oakville, ON

Description: Context: According to the 2013 Canadian Diabetes Association (CDA) guidelines, bariatric surgery should be considered for type 2 diabetes mellitus (DMII) with obesity II (BMI = 35.0 kg/m2 to 39.9kg/m2) with comorbidities (CM) and obesity III (BMI ≥ 40 kg/m2), after failure of standard weight loss medical therapies. An estimated 80% to 90% of patients with DMII are overweight/obese. Higher BMI in DMII is associated with increased overall mortality. Objective: To determine if eligible type 2 diabetic patients with obesity were offered bariatric surgery. Design: Cross-sectional study. Participants: We identified 248 DMII patients with obesity II (with/without microvascular complications, ie, retinopathy, neuropathy, nephropathy, cataracts and/or macrovascular complications such as erectile dysfunction, coronary artery disease, cardiovascular disease) and with obesity III, who visited Halton Family Health Centre Clinic (HFHC), Burlington, Ontario, between 2013 and 2014. They were divided according to age—40 to 69 years and ≥70 years—and HbA1C—7.0 to 7.9 and ≥ 8.0. Intervention: Analysis of EMR data from HFHC. Outcome measures: Offers of bariatric surgery to eligible patients and the influencing factors. Results: Out of 248 DMII with obesity II/III,133 were male and115 female. Of these 248, 219 patients were in the aged 40 to 69 years group, and 39 were 70 years or older. HbA1C was 7.0 to 7.9 for 52, and ≥8.0 for 41 patients. Eighty-three patients had obesity II(CM), and 85 had obesity III. Only 31 patients (16 male, 15 female) were offered bariatric surgery regardless of HbA1C and comorbidities; 28 were aged 40 to 69 years and 3 were ≥70 years. Twenty-five patients were obesity III and 6 were obesity II (CM). In all, 155 patients were eligible for bariatric surgery. Conclusions: Only 28 out of 155 (18%) eligible patients were offered bariatric surgery, despite it being covered by OHIP. All parameters, eg, age, gender, HbA1C, were comparable except BMI. Obesity III patients were four times more likely to be offered bariatric surgery, compared to obesity II (CM) patients. Despite the CDA guidelines,127 (82%) eligible patients were never offered bariatric surgery. Obese DMII patients have greater difficulty with weight loss. Even a modest weight loss of 5% to 10% substantially improves insulin sensitivity, glycemic control, hypertension, and dyslipidemia, decreasing overall mortality. Bariatric surgery is a safe and effective option resulting in sustained weight loss and significant improvement in obesity-related comorbidities. Increasing physicians' awareness of the 2013 CDAG recommendation through continuing medical education, medical journals, peer discussion, etc., is required.

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Development and Dissemination of a Preconception Health Care Tool in Primary Care

Lindsay Bevan, BAH, Toronto, ON; Rebekah Barrett, MN, NP-PHC, Toronto, ON; Lena Salach, BA, MA, Toronto, ON; Amanda van Hal, BSc, Toronto, ON; Deanna Telner, MD, MEd, CFPC, FCFP, Toronto, ON

Description: Context and objective: Good health begins even before conception. Recommendations from the No Time to Wait: The Healthy Kids Strategy suggest that optimizing patients' health before conceiving will improve their children’s chances of enjoying good health throughout their lives. In response to these recommendations, the Ontario Ministry of Health and Long-Term Care engaged the Centre for Effective Practice fmf.cfpc.ca

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(CEP), in partnership with the Ontario College of Family Physicians, to develop and disseminate the Preconception Health Care Tool (PHCT). The tool is designed to improve maternal and infant health outcomes in primary care by guiding providers’ discussions of health promotion and illness prevention strategies with all patients of reproductive age. Design: The tool was developed using CEP’s integrated knowledge translation approach. A working group comprised of a primary care nurse practitioner, a family physician, and CEP staff conducted a comprehensive search, review, and appraisal of existing clinical evidence. Through this process the working group integrated all available evidence and resources into one tool. The tool was tested and refined based on feedback from individuals and organizations with expertise in maternal and infant care, and from providers who practise comprehensive family medicine. Results: The tool presents information for providers to use over a series of visits with their patients of reproductive age to encourage patients to develop a reproductive life plan; assess and optimize patients’ preconception physical and mental health; optimize chronic medical conditions prior to conception; choose safe medications for women who might become pregnant; and counsel on lifestyle habits (nutrition, physical activity, alcohol, tobacco, and other substances). Current patient and provider resources are included throughout the tool. Preliminary data on dissemination has been collected and analyzed. Since the launch of the PHCT webpage in March 2015, it has received over 2100 views. Additional dissemination data will be presented and discussed.

Conclusion: The PHCT might help standardize primary care providers’ approach to preconception health care with all patients of reproductive age, and provide guidance and resources to both providers and patients.

Impact of Breast Reduction Surgery on Breastfeeding: Systematic review and meta-analysis

Roni Kraut, MD, Edmonton, AB; Christina Korowynk, MD, CCFP, Edmonton, AB; Lauren Katz, BSc, Winnipeg, MB; M. Shirley Gross, MD, CCFP, Edmonton, AB; Sandy Campbell, MLS, Edmonton, AB; G. Michael Allan, MD, CCFP, Edmonton, AB

Description: Context: The World Health Organization recommends exclusive breastfeeding up to six months, with continued breastfeeding, along with appropriate complementary foods, up to two years of age or beyond, due to breastfeeding's significant health benefits.

Breast reduction is a common plastic surgery performed in Canada and United States. The impact of this surgery on breastfeeding is currently unclear in the literature. Objective: To determine the impact of breast reduction surgery on breastfeeding. Design: Systematic review and meta-analysis. Participants: Studies were included if they provided both the absolute number and percentage of women successful at breastfeeding or lactation following breast reduction surgery. Intervention/Instrument: A medical librarian conducted the literature search. Two independent reviewers reviewed each paper. References of papers meeting the inclusion criteria were reviewed for completeness. Within the search, two systematic reviews were identified; references of these were also reviewed.

For each accepted study, two independent data extractors captured data on the profession of the study authors, study characteristics, type of breast reduction surgery, patient satisfaction with surgery, preoperative discussion on breastfeeding, and number successful at breastfeeding. Outcome measures: Number of weeks of exclusive or any breastfeeding, percentage of patients satisfied with surgery, percentage of patients with whom breastfeeding was discussed preoperatively, and breastfeeding outcomes by surgery type. Results: Preliminary results of the literature search yielded 495 unique papers; 384 were excluded by title or abstract and 60 were excluded on full paper review, leaving 51 papers for data extraction. A further 15 papers were accepted following reference review. The accepted papers were published from 1946 to 2014, and the main outcome in approximately 40% of the papers was breastfeeding postsurgery. Conclusion: The final results will provide guidance to plastic surgeons as well as general practitioners on counseling women about breastfeeding before and after surgery, and on whether additional breastfeeding support should be provided to these women.

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Maternal Food Choice and Infant Feeding

Melanie Hnatiuk, MSc, MD, CCFP, Calgary, AB; Monica Kidd, MSc, MD, CCFP, Calgary, AB

Description: Context: Exclusive breastfeeding for the first six months of life has long been considered part of optimal infant nutrition, yet many women discontinue breastfeeding before this. Anecdotal clinical experience suggests that concerns about which foods are safe and appropriate for women to eat while breastfeeding, particularly women’s concerns about foods that are thought to cause “gas” or colic, contribute to early cessation. In spite of limited published evidence of any causal link between maternal diet and infant behaviour, we have seen women adopt extreme avoidance diets or stop breastfeeding altogether. Objectives: To investigate patterns of food restriction while breastfeeding among women in Calgary, and to explore the reasons why some women food restrict while breastfeeding. Design: Qualitative study using semistructured interview guide, followed by thematic analysis. Outcome measures: Women’s experiences breastfeeding young infants, especially with respect to diet choice. Findings: Data collection is ongoing at the time of abstract submission, but preliminary analysis suggest it is very common for breastfeeding women of young infants to attribute unsettled infant behaviour (eg, crying or other pain behaviours, sleep disturbance) to breastfeeding, especially perceived milk supply. Also, women heard from peers, family, and sometimes health care providers that certain foods “cause” colic, and some women subsequently avoided those foods. Women felt judged on their infant-feeding choices, and remarks made by those around them contributed to their feelings of being a good or bad mother. Women expressed frustration at receiving conflicting information on breastfeeding, and often ranked information from family and friends as more important than information received from health care providers. Discussion/conclusions: Infant behaviour, though multifactorial, is often considered by mothers to be a proxy measure of milk “goodness,” and when an infant is fussy, women are quick to blame their milk and themselves. Women’s ability to breastfeed is

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE tightly linked to their self-esteem and confidence as mothers, so in the absence of causal links between maternal diet and infant behaviour, health care providers should help support breastfeeding women to eat balanced diets, and reassure them that infant fussiness is often developmental, not pathological.

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Keeping Kids in the Conversation: Understanding children’s perspectives of visits to the general physician Jessica Dalley, BA, Guelph, ON; C. Meghan McMurtry, PhD, CPsych, Guelph, ON

Description: Context: Visits to the general practitioner (GP) play an important role in the promotion of Canadian children’s health, yet research regarding children’s perspectives of GP visits is scarce. Objective: Obtain children’s perspectives of GP visits to determine how these experiences can be improved. In particular, this study focused on children’s reports of their positive and negative experiences at the GP visits, as well as children’s desire for increased information and involvement in their health care. Design: This is a qualitative, descriptive study. Consistent with the principles of patient-centred care, which emphasize the importance of actively involving patients in their own medical care, this study involved interviewing children directly. Introduction: Greater understanding of children’s medical fears is essential to informing interventions for managing procedural distress and pain during GP visits. The current study aims to understand children’s fears specific to GP visits, including fear of medical procedures (eg, needles), fear of experiencing pain, fear of illness, and fear of feeling uninformed about upcoming medical procedures. Equally as important, we asked children to describe their positive experiences at GP visits so these can be increased. Method: One hundred sixty-seven participants (sufficient to detect medium effect size at P = .80, α = 0.05) in grades two to four (ages 7 to 10 years, Mage = 8.07) underwent structured interviews regarding their perspectives of GP visits. Anticipated results: All study data has been collected. Participant interview responses will undergo content analysis, which is the systematic and objective description of spoken communication. Participant responses will be coded into the following general categories: what children like/dislike about GP visits, how GP visits can be improved, children’s medical fears, and how to involve children in conversations about their health care. Conclusion: By obtaining children’s perspectives directly, the current study can provide information and guidance for improving GP visits for Canadian children through the lens of patient-centred care. This includes promoting positive experiences at GP visits, managing procedural pain and fear, and increasing preparatory information provided to children about medical procedures. Involving children in their primary health care might help increase children’s understanding of health concepts and prepare them for making medical decisions in adulthood.

527 Examining Patterns in Medication Documentation of Trade Names and Generic Names in an Academic Family Practice Training Centre

Carly Ruderman, MSc, MD, CCFP, Toronto, ON; Alexander Summers, MD, CCFP, Toronto, ON; Morgan Slater, MSc, PhD, Toronto, ON; Fok-Han Leung, MD, CCFP, Toronto, ON

Description: Context: Medical education is increasingly recognizing and addressing the influence of the pharmaceutical industry on academic physicians and trainees. Among many changes medical institutions have made to try to eliminate directing biased information toward trainees is a restriction on the use of trade names in formal lectures and teaching settings. It is unknown whether there has been a similar trend toward generic name use and documentation in the clinical teaching setting. Objective: To compare the use of generic versus brand names for pharmaceutical products in clinical documentation in an urban academic family practice centre. Methods: A systematic retrospective chart review of the electronic medical records for St Michael’s Academic Family Health Team (SMAFHT) was completed, analyzing data present in each patient’s cumulative patient profile on August 1, 2014. Charts were analyzed for their documentation patterns of 20 commonly prescribed medications, with respect to generic or trade name use. The data were also analyzed for the significance of physician characteristics, such as years from graduation and clinic site, associated with documentation patterns. Results: For the 20 medication combinations of interest, only 32% of patient charts contained generic nomenclature exclusively. Conversely, 45% of patient charts contained only trade nomenclature, and 23% contained a mix of generic and trade nomenclature. Among the physicians at the SMAFHT included in the study, there was large variation in the use of generic nomenclature in charts, which ranged from less than 10% to nearly 90%. There was no association seen between the exclusive use of generic nomenclature and the number of years since graduation from medical school.

No significant difference in documentation patterns was found between the five sites of the SMAFHT. Conclusions: Trade names continue to be used abundantly in documentation in medical charts at an academic family health team. The use of generic names and trade names varies widely by both the medication of interest and the prescribing physician. Further study is necessary to determine the characteristics of a physician that influence the use of generic or trade nomenclature.

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Implementation of Pharmacogenomics Into Primary Care In British Columbia

Martin Dawes, MBBS, CCFP, MD (Lond), DRCOG, FRCGP, Vancouver, BC; Diana Dawes, MSc, Vancouver, BC; David Chong, MBBS, Vancouver BC; Lily Edelson, MBBS, Vancouver, BC; Marta M. Guarna, PhD, Vancouver, BC; Hagit Katzov-Eckert, PhD, Vancouver, BC; Nathan Heinrichs, MBBS, Vancouver BC; Paul Stanley, MBBS, Vancouver, BC; Robert Fraser, PhD, Vancouver, BC; Pieter R. Cullis, PhD, Vancouver, BC

Description: Context: Physicians cannot predict whether a patient will gain the desired benefit from a prescribed medication or whether they will experience harmful side effects. Genetic tests might reduce this potential harm for many medications. Objective: To determine whether it is feasible to use genetic information to drive a decision support tool. Design: Feasibility cohort study. Setting: Family physician offices and pharmacies. Patients: Two hundred fifty patients in total: 200 from five family practices, 50 from a pharmacy. Inclusion criteria: Adults aged ≥18 years that have a diagnosis of gout, chronic obstructive pulmonary disease, depression, osteoarthritis, hypertension, hyperlipidemia, atrial fibrillation, asthma, osteoporosis, and/or epilepsy. Exclusion criteria: Pregnant or breastfeeding. Intervention: The participant gives a saliva sample, from which the genotype is analyzed. A panel of single nucleotide polymorphisms (SNPs)—33 SNPs in five genes that involve in the absorption, distribution, metabolism, and excretion (ADME) of medications used for common chronic diseases—is tested. Within the research computer (TreatGx) are medication logic trees that combine genetic information with data from the EMR (past medical history, medication prescriptions, and laboratory test results). Using this information, and the highest levels of published medical evidence, TreatGx makes recommendations of medications to prescribe. Next time the patient sees the family physician/pharmacist, information is exchanged between the two servers enabling prescribing recommendations to appear on the family physician’s/pharmacist’s screen. Outcome measures: Feasibility of recruitment, feasibility of obtaining SNP data, feasibility of integrating SNP data into EMR, use of decision support by family physicians and fmf.cfpc.ca

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Targeted Genetic Testing to Increase Efficacy and Safety of Medications in Primary Care

Martin Dawes, MBBS, CCFP, FRCGP, PhD, Vancouver, BC; Hagit Katzov, PhD, Vancouver, BC; Diana Dawes, MCSP, Vancouver, BC; Marta Guarna, PhD, Vancouver, BC; Hagit Katzov, PhD, Vancouver, BC; Lily Edelson, MBBS, Vancouver, BC; David Chong, MBBS, Vancouver, BC; Nathan Heinrichs, MBBS, Vancouver, BC; Paul Stanley, MBBS, Vancouver, BC

Description: Objectives: To describe the role of genetic variation that affects individual response to drugs; to outline the process to select genetic markers that have clinical utility; to assess the application of pharmacogenomics in primary care. Background: Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality. These ADRs might be avoided through personalized drug treatment based on genetic markers. Studies in pharmacogenetics have shown that genetic variants such as single nucleotide polymorphisms (SNPs) in genes involved in drug metabolism and transport influence an individual’s drug response. Here we describe the selection of a pharmacogenetic SNP panel developed as part of a decision support tool and its application in primary care. Aim: To integrate a panel of clinically effective SNPs using an evidence-based approach into a decision support tool for prescription known as TreatGx. Methods: Evidence for genotype-guided dosing recommendations was compiled for a wide selection of drugs commonly prescribed by family physicians to treat multiple acute and chronic diseases. SNP variants were ranked according to clinical annotations from PharmGKB, Clinical Pharmacogenomics Implementation Consortium, and FDA guidelines. Commercially available SNP panels were evaluated for inclusion of clinically relevant genetic markers. These were cross-matched against potential medication selection algorithms and current guidelines for relevance and applicability. Results: We have identified a validated pharmacogenetic SNP panel that includes genes involved in the absorption, distribution, metabolism, and excretion (ADME) of drugs developed by the PharmaADME Consortium and available from Life Technologies. This panel included 33 of the top-ranking SNPs in five genes of relevance: CYP2D6, VKORC1, CY2C9, CYP2C19, and SLCO1B1. Conclusions: The addition of clinically relevant genetic markers to the decision support tool will optimize personalized prescription recommendation in primary care and might result in clinically important reduction in ADRs. 530

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pharmacists, reported usability of tool. Anticipated results: Recruitment of, and saliva samples from, 250 people over a three-month period. Samples analyzed within five days of donation. Decision support accessed for more than 75% of patients recruited. Future: Information will be used to design a randomized controlled effectiveness trial. The primary outcome will be adverse drug events.

Engaging Inner-City Populations and Stakeholders in Health Services Research

Lara Nixon, MD, CCFP, FCFP, Calgary, AB; Ginetta Salvalaggio, MSc, MD, CCFP, FCFP, Edmonton, AB; Elaine Hyshka, MSc, Edmonton, AB; Jennifer Nichol, MD, FRCPC, Calgary, AB; Kathryn Dong, MD, FRCPC, Edmonton, AB; Shireen Surood, PhD, Edmonton, AB

Description: Context: Inner-city populations are characterized by medical and social complexity, low uptake of chronic disease prevention and screening (CDPS), and low primary care attachment. Hospital visits are a primary health care access point—providing an opportunity to respond to unmet needs as well as to connect individuals to primary and community-based care. Objective: To determine whether an inner-city acute care team intervention is associated with reduced emergency department (ED) use, increased primary care attachment, and increased CDPS. Inner-city populations are generally understudied due to challenges in recruitment, retention, and data quality; these challenges need to be carefully considered in study designs. Design: Two-group pre and post quasi-experimental design. Community liaisons (CLs) meet regularly with the research team, convene a community advisory group quarterly, and provide support for follow-up efforts in the community. Participants provide informed consent for 1) collection of primary survey data (baseline, 6 months, and 12 months); 2) secondary health, housing, income support, and policing administrative data over the same time period; and 3) data linkage. Participants: Patients presenting to acute care with active substance use, unstable housing, or unstable income. Intervention: The Addiction Recovery and Community Health (ARCH) team utilizes a multidisciplinary teambased approach to address unmet medico-social needs, population-specific care coordination and discharge planning. Outcome measures: 1) Total ED use; 2) attachment to a primary care provider; 3) family practice sensitive condition presentations to the ED; 4) stabilization or reduction of substance use; and 5) uptake of CDPS. Results: ARCH launched in July 2014 and conducts approximately 20 consultations weekly. Baseline characteristics of the study sample will be presented. Based on past local data, we expect CL-supported follow-up activities to achieve a 50% retention rate. One hundred per cent of participants have consented to data linkage of survey and administrative data sets, allowing for comprehensive characterization of all participants both medically and socially, regardless of retention. Conclusions: ARCH is designed to provide interim supports for a vulnerable population, traditionally underserved and understudied by primary care. Strong partnerships with service providers, data custodians, and community members create an environment in which inner-city health services research is feasible.

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Endoscopic Knowledge, Skills, and Practice Patterns of Canadian Family Physician Endoscopists Michael Kolber, MD, MSc, CCFP, FCFP, Edmonton, AB; Shelley Ross, PhD, Edmonton, AB

Description: Context: Currently excessive wait times highlight a shortage of colonoscopists in Canada. Patients in rural communities also face substantial geographic challenges in accessing care for their gastrointestinal concerns or symptoms. To fill this need, some rural family physicians have been trained in gastrointestinal medicine and provide endoscopic services to their local communities.

However, there is a paucity of evidence on skill set, practice patterns, and knowledge (and educational needs) of Canadian family physician endoscopists. Objective: To determine the training, practice patterns, endoscopic skillset and knowledge of Canadian

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE family physicians who routinely perform endoscopy. Design: Cross-sectional survey. Participants: Family physician endoscopists at an annual educational event aimed at family physician endoscopists (January 2014), with additional recruitment targeted to previous conference attendees. Instrument: Self-report survey accessed online. Results: Family physician endoscopists (n = 20; 90% male; representing 5 provinces [BC, AB, SK, ON, NWT]) completed the survey. Among respondents, 95% practised in rural settings; 65% were in communities without a local general surgeon, and 55% were at least a two-hour drive from the nearest gastroenterologist. Respondents reported both formal and informal training. All respondents performed gastroscopies, and 90% performed colonoscopies and polypectomies. On average, respondents performed endoscopy 4 days per month. All but one physician performed their own sedation at least some of the time, most commonly with fentanyl and mdazolam. The majority routinely photograph cecal landmarks (76%) and tattoo advanced polyps or cancers (70%), while 94% feel able to intubate the terminal ileum when needed. Most felt they had adequate knowledge on the majority of general gastrointestinal or endoscopic topics but identified needing education in areas such as advanced care of patients with inflammatory bowel disease and staging rectal cancer, and Barrett’s esophagus nomenclature. All endoscopists except one felt supported by their local colleagues and the majority felt supported by their colleagues in gastroenterology to whom they refer. Conclusion: Family physician endoscopists appear to be filling a need in caring for rural Canadian patients with gastrointestinal symptoms or concerns. Ongoing studies to directly measure endoscopic performance of these physicians should be performed and knowledge gaps should be addressed at future educational events.

532 Working Together for Rural Patients: Supporting sustainable rural practice through improved access to specialist care

Ella Monro, MD, Princeton, BC; Lisa Needoba, d Care Project Lead

Description: As a result of a shared care project to locate specialist care in a small rural community, family physicians feel less isolated and better supported to provide quality care to patients—and specialists feel they are making a significant contribution to more equitable health care in British Columbia. Located in the southern interior, the Princeton area population is approximately 5400 people, served by a small local hospital. There are no specialists residing in the region and the ability to retain family physicians has been a persistent challenge. Traveling 1.5 or more hours through mountainous terrain to see a specialist is a real difficulty for many, resulting in frequently missed appointments.

In 2013, Penticton specialists and Princeton physicians discussed the challenges of isolation from specialist care and advice in rural practice.

With the support of the Shared Care Committee (a collaborative committee of Doctors of BC and Ministry of Health) and the South Okanagan Similkameen Division of Family Practice, a shared care project started to improve Princeton access to specialist care and support for family physicians. Representatives from the Princeton family physician medical clinic, Interior Health Authority, Penticton specialists, and Shared Care project staff set out to attract specialists to hold outreach consultation clinics in Princeton. When the project started there were four specialties available through the outreach clinics to Princeton area patients. In one year this number had grown to 13 specialists from 11 different specialties, many offering a lunchtime continuing medical education opportunity for Princeton physicians and the nurse-practitioner.

In 2014, approximately 400 patient trips were avoided, through nearly 50 outreach clinics. Among the patients, 96% kept their appointments, and 30% of patient respondents said they either would not have seen a specialist or don’t know how they would have gotten to an appointment in a larger centre. A participating general surgeon remarked, “It is the most rewarding thing I've done in 10 years.” The family physicians find it is a model of care that makes rural practice more attractive and sustainable.

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Can We Meet the Needs of Regina’s Emergency Department and Hospitalist Frequent Users?

Sarah Liskowich, MD, CCFP, Regina, SK; Erwin Karreman, PhD, RHIS, Regina, SK; Kiel Luhning, MD, Halifax, NS

Description: Context: In Regina, a small percentage of patients repeatedly access acute care services at a huge cost to the medical system. In 2013, the Hospitalist Referral Program (HRP) was implemented with a goal to better meet the needs of these frequent users who are seen repeatedly in the emergency department (ED) and frequently admitted briefly to the hospitalist program without outpatient follow-up. These patients continually return to the hospital for their ongoing care, propagating a cycle of numerous brief admissions, creating dependency on acute care services for non-emergent problems. Physicians from the family medicine unit accepted HRP referrals and provided outpatient care at a community clinic. Objective: The purpose of this study is to evaluate the success of the HRP by taking into account medical as well as monetary parameters. Design: Data collection entailed six months' prior and post referral to measure the varying outcomes. To this end, the charts of 24 patients with a mean age of 39.6 (± 15.8) years were reviewed. Patients were categorized as successful or unsuccessful referrals based on whether they showed up for their first appointment and whether they regularly showed up for ensuing ones. This categorization was used to compare reduction in ED visits and monetary savings. Monetary savings were calculated by comparing pre- and post-referral expenses associated with cost of transportation, hospital-related costs, and costs of outpatient appointments. Results: Fifty per cent of referred patients were considered successful referrals. Patients in the unsuccessful group showed an average drop of 2.0 (± 2.7) ED visits compared to a drop of 3.3 (± 4.3) visits for patients in the successful group. In addition, monetary savings through implementation of the HRP were estimated to be an average of $6.6K (± $9.7K) for the unsuccessful referrals and almost double that ($12.6K ± $18.3K) for the successful referrals. Conclusions: Future research examining the traits of patients that successfully used the HRP would indicate whether more programs of this kind are needed or whether other solutions to this problem are required. Measuring this program’s success informs ways to make positive impacts on health delivery in the Regina Qu’Appelle Health Region.

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Provider Perceptions of Knowledge Exchange and Communication Within a Multisite Family Health Team

Morgan Slater, PhD, Toronto,ON; Emily Nicholas, BSc, Toronto, ON; Fok-Han Leung, MD, MHSc, CCFP, Toronto, ON; Aisha Lofters, MD, PhD, CCFP, Toronto, ON

Description: Context: Team-based care is common in today’s primary health care system. However, team members might be spread across multiple locations. While this allows for greater access throughout a community, separation of team members might negatively affect communication and lead to disparate patient access. Objective: To describe the self-reported knowledge and utilization of family health team (FHT) services and to explore communication issues among health care professionals active within a large, multisite FHT. Design: Electronic survey.

Participants: All health care professionals active within a multisite FHT in Toronto, Ontario, were invited to participate (n = 90). Interventions: The survey captured: 1) demographics, including the respondent’s role and length of experience, 2) knowledge and use of services within the FHT, and 3) perceived communication issues within the FHT. Main outcome measures: This descriptive study assessed self-reported awareness of FHT services, perceptions of patient access, and communication issues. Results: Forty-six health care professionals participated fmf.cfpc.ca

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Introducing Diagnostic Ultrasound in an Academic Family Health Team

Brent Wolfrom, MD, CCFP, Kingston, ON; Emily Pollock, MSc, Kingston, ON; David MacPherson, MD, CCFP, Kingston, ON; Eric Sauerbrei, MD, FRCP, Kingston, ON; Jyoti Kotecha, MPA, CChem, MRSC, Kingston, ON

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(51% response rate). While respondents were highly aware of the clinical resources and services offered at their site of practice (95% agreed/strongly agreed), only 54% were aware of services offered at other sites within the FHT. While internal referrals for certain specialty services were high (ie, methadone management, obstetrical care, IUD insertions, and psychiatry), less than 50% of other referrals were internal despite physicians within the FHT having the expertise (eg, sports medicine, joint injections). Only 60% of respondents believed that patients have equal access to all FHT services and 42% reported that patients are unlikely to travel between sites. Roughly one-quarter of respondents believed that physicians were unlikely to refer patients to another site within the FHT for health care services. A majority of respondents (68%) agreed that the geographic separation of the sites negatively affected communication. Conclusions: Geographical separation of team members in a multisite FHT had a negative impact on provider knowledge of available services, perceived patient access, and communication within the team. As the majority of FHTs are spread across multiple locations, finding ways to improve communication among team members is key to maximizing the effectiveness of the patient care provided by these team-based models of care.

Description: Context: Diagnostic ultrasound provides a powerful tool for point-of-care investigations, cost-effective screening, clinical decision making, and medical education. However, it has not made significant inroads to outpatient-based care. There is very little data available on how to best teach diagnostic ultrasound to family medicine residents. Objectives: To determine the feasibility of introducing a diagnostic ultrasound into a family medicine teaching practice. Using the abdominal aortic aneurysm (AAA)–focused screening examination, this study aims to 1) assess the identification rate of AAA, 2) assess the competency of family physicians in the performance of basic diagnostic ultrasound, and 3) determine the perceived educational value to and comfort of family physicians in the performance of basic diagnostic ultrasound. Design: Department of family medicine faculty physicians and R1 residents are trained in basic diagnostic ultrasonography. Patients who meet the Canadian Society for Vascular Survey guidelines are recruited ad hoc, and screened for AAA by either a faculty physician or resident under supervisor. The same patient is also referred to the Radiology Department to receive a diagnostic ultrasound scan by a trained ultrasonographer with interpretation by a radiologist.

Results are contrasted for consistency and reliability. At six months post ultrasound training, participating faculty physicians and residents are surveyed to determine their self-reported comfort and the perceived educational value of training. Participants: 1) Patients who consented and fit the Canadian Society for Vascular Surgery screening criteria; 11 have been scanned to date. 2) Faculty physicians and residents who participated in training; 7 have consented to date. Intervention: A diagnostic AAA scan by a recently trained family physician. Results: Analysis is ongoing. Conclusions: Preliminary results indicate that the diagnostic ultrasound is being used by family physicians as a point-of-care tool and is being well received by patients.

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Accessibility and Use of Primary Health Care Among Immigrants in the Niagara Region Irene Lum, BASc (Hons), North York, ON; Rebecca Swartz, BScN, St Catharines, ON; Matthew Kwan, PhD, St Catharines, ON

Description: Context: Research on immigrant health in Canada has been fairly well established; however, the focus has typically been on large urban centres such as Toronto, Montreal, and Vancouver, which have large immigrant population. As a result, immigrants and their experiences with the healthcare system in smaller regions remain largely unknown. Objective: The purpose of this study was to examine the lived experiences of immigrants in the Niagara Region, in order to identify specific barriers to use and access of the primary healthcare system and to better understand the unique challenges they faced when requiring primary care. Design: This was a qualitative study employing semi-structured interviews with all participants. Each interview was recorded, transcribed, and coded for emergent themes using a constant comparison approach on NVivo software. Participants: The study included 14 participants that were OHIP-eligible immigrants currently residing in the Niagara Region. Age of the participants ranged from 31 to 62, with the majority being female (64%). Half of the participants had lived in Canada for less than 4 years. Findings: Overall, five emergent themes were found to impact primary care access, the primary care experience, or both. Specifically, social isolation, lack of OHIP coverage, the existence of a language barrier, difference in treatment preferences and geographic distance were found to be salient contributors to difficulties in accessing primary healthcare. Conclusion: This study is the first to examine the primary healthcare experiences of immigrants in a smaller urban centre. In comparison to similar studies conducted in larger cities, these findings suggest that immigrants identify similar barriers to primary care. It is likely, however, that these barriers may be further exacerbated in places such as the Niagara Region due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. Strategies to improve immigrant healthcare experiences in larger cities may not necessarily be effective in smaller regions due to differences in geographic and demographic characteristics. Thus, more research is required to understand effective ways to overcome primary healthcare barriers for immigrants moving to smaller urban centres.

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Knowledge Translation for Family Physicians: Making good strategies even better

Joanne Permaul, BSc (Hons), MA, CCRP, Toronto, ON; June C. Carroll, MD, CCFP, FCFP, Toronto, ON

Description: Context: Knowledge translation (KT) involves transferring knowledge acquired through research to application in practice. KT

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE interventions have the potential to bridge the gap between knowledge and practice, potentially leading to improved health outcomes. It is important to evaluate the effectiveness of knowledge dissemination and implementation strategies and to make recommended improvements.

Objective: To evaluate three KT strategies: an interactive educational workshop with resource materials (GenetiKit), including a just-in-time knowledge support tool called Gene Messenger (GM); a hereditary colorectal cancer (CRC) risk triage/management point-of-care tool; and an electronic knowledge dissemination service (e-Gene Messenger), to determine what improvements can be made to KT strategies based on recommendations from family physicians (FPs). Design: Quantitative and qualitative data were analyzed from evaluation questionnaires completed at the end of each study to determine if the KT programs were useful, the aspects that were valued by FPs, and how KT efforts could be improved. Participants: Canadian FPs. Results: Overall, these three KT strategies were evaluated highly by participating FPs. Of 42 FPs who evaluated the GenetiKit program, 88% found it useful; 76% said their practice changed a little and 21% said it changed a lot; 93% would recommend GMs to colleagues. Of 73 FPs who used the CRC risk triage/management tool, 70% found the risk triage tool, and 86% found the management tool, easy to use; and 90% stated that the tool would improve their practice. The GM program was evaluated by 381 FPs: 88% were somewhat/very satisfied with the service; 88% found this method of learning somewhat/very useful; and 76% found it useful for clinical practice. A synthesis of qualitative comments from the studies revealed the following recommendations for further improving KT strategies for FPs: practical point-of-care clinical tools; concise information with links to additional material if needed; convenient access to a trusted source of information; information tailored to FPs; website for future reference; and tools for hand-held devices and the electronic medical record. Conclusion: KT strategies have the potential to influence physician behaviour and improve health outcomes. Future KT strategies for FPs should be designed based on lessons learned from their feedback and recommendations.

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Scoping Study of Communication Barriers Between Physicians and Immigrant Patients

Tanvir Turin Chowdhury, MD, PhD, Calgary, AB; Salim Ahmed, MSc, Calgary, AB; Nusrat Shammu, MSc, Calgary, AB; Nahid Rumana, MD, PhD, Calgary, AB

Description: Introduction: Immigrant people all around the globe are commonly challenged by communication barriers in their everyday life. This barrier becomes severe when they must communicate with their doctors about their health conditions. As a vast number of people of the world are now immigrants (1 in every 7 people is living outside his or her country of origin), we need to understand the causes of this communication barrier and its effects on both doctors and immigrant patients. So far numerous original studies have taken the effort to shed light on the communication barriers between immigrant patients and doctors, but a synthesis of existing knowledge is required to identify the gaps as well as opportunities for future research and study. Method: We have done a scoping review of the literature to synthesize knowledge according to the research objective stated above. We used a standard scoping review framework according to Arksey and O’Malley (2005). We searched electronic databases of journal articles and grey literature and also used the snowballing technique to further expand the number of relevant literature. We limited our search to English-language literature only. Results: The searches returned 567 entries after removal of duplicates.

Screening based on titles and abstracts selected 131 articles for full-text read. After full-text read, 61 articles were found for the synthesis.

Language discordance between doctor and patient appeared as the most critical barrier in communication. However, cultural difference, religion, lack of knowledge, and socioeconomic status significantly impair effective communications. Lack of appropriate communication creates frustration among doctors and patients, mistrust and anxiety among patients, and ultimately worsen patients’ condition and psychological well-being. Conclusion: Based on existing literature, this study depicted the facts and gaps in research about communication barriers that immigrant people encounter while accessing health care. Therefore, it can be considered as evidence of information which professionals such as doctors, policy makers, and researchers can use in finding their future directions on this issue.

539 Geographic Distribution of Scientific Contributions in Family Medicine: A bibliometric analysis of Canada’s contribution

Tanvir Turin Chowdhury, MD, PhD, Calgary, AB; Fahmida Yeasmin, MSc, Calgary, AB; Salim Ahmed, MSc, Calgary, AB; Arfan Raheen Afzal, MSc, Calgary, AB; Nahid Rumana, MD, PhD, Calgary, AB

Description: Introduction: Publication of scientific articles in peer-reviewed medical journals is considered as a measure of research productivity. The aim of the present study was to quantify the research contributions of different countries in family medicine and to critically discuss the results through the prism of recent socioeconomic parameters. Materials and methods: All the articles on “family medicine” published between 2009 and 2013 (five years) were selected and downloaded from the MEDLINE database. The following key words were used for the search: “General Practitioner,” “Family Practice,” “Family Physician,” “General Practice,” “Family Medicine,” and “Family Doctor.” These articles were coded for publication year, country of first author's affiliation, and article type. We have investigated the share of research output of the top-ranking 20 countries along with the trend over time. Also, we have investigated this share of research output weighted by other factors such as gross domestic product (GDP), population, per capita income, and research-and-development expenditure of GDP of each country.

Results: The search generated 12 129 papers (853 clinical trials, 331 case reports, 55 meta-analyses, 908 reviews, and 9982 original articles).

In terms of publication volumes, the United Kingdom (20.7%), the United States (19.76%), and Australia (10.1%) were the most productive countries. Canada was the fifth-most productive country, with 5.6% of the articles. When adjusted for country population, Denmark (6.1 out of 105), Netherlands (5.5 out of 105), and New Zealand (5.4 out of 105) occupied the highest ranks. These three countries also occupied the top three positions while GDP was accounted for. Canada was in ninth position for publication/population and was in tenth position for publication/GDP. Conclusion: Along with the United Kingdom, the United States, and Australia, Canada is one of the top contributors for family medicine–related research. But a comparison using GDP and the percentage of GDP spent on research and development showed that smaller European countries are more productive. With primary care being one of the important aspects of Canada, the barriers to boosting quality research in Canada should be determined and, accordingly, appropriate measures should be taken forthwith.

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POEMs Reveal Candidate Clinical Topics for the Choosing Wisely Canada™ Campaign Roland Grad, MD CM, MSc, FCFP, Montreal, QC; Sarah Ousalem

Description: Objectives: We propose a method of identifying clinical topics for expert panels involved in campaigns like Choosing Wisely Canada.

Methods: POEMs are tailored synopses of original research or systematic reviews, selected by searching over 100 journals. Delivered to over 20 000 members of the Canadian Medical Association (CMA) by email, the daily POEM is rated by physician members of the CMA with the validated Information Assessment Method (IAM), in the context of an ongoing continuing medical education program. From the fmf.cfpc.ca

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Une étude pilote d'implantation du site web Discutons Santé en milieux cliniques de première ligne.

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readers’ perspective, the IAM questionnaire captures the perception of the clinical relevance of this information, the intention to use this information for a specific patient, and any expected health benefit. We analyzed all ratings submitted by CMA members on all POEMs delivered in 2014. Given the objective of the Choosing Wisely Canada campaigns, we focused our analysis on one specific item in the IAM questionnaire, namely the expected health benefit from "avoiding an unnecessary diagnostic test or treatment." For each POEM, we obtained frequency counts of the number of these "avoid" ratings. This allowed us to identify the top 20 POEMs in 2014 associated with this type of health benefit. Then, to determine if the clinical topic of these 20 POEMs was included in the master list of the Choosing Wisely Canada campaign, two of us independently searched this list by keyword and topic area, in March 2015. Disagreements were resolved by consensus. Results: In total, 291 804 ratings were submitted on 254 POEMs in 2014. For the set of 20 POEMs of interest, we received an average of 1245 ratings per POEM (range 468 to 1459). Of the clinical topics addressed by these 20 POEMs, just two were the subject of a recommendation from the Choosing Wisely Canada campaign. The clinical topics of the other 18 POEMs were not addressed. We grouped these 18 POEM-topics into three categories: 1) diagnostic testing (n = 3), 2) medical intervention (n = 12), 3) surgical intervention (n = 3). Conclusion: The selection of new recommendations for Choosing Wisely Canada could be informed by a systematic crowd-sourcing approach based on POEMs.

Marie-Thérèse Lussier MD, BSs, MSc, FCMF Montréal QC; Catherine Hudon MD, PhD, Sherbrooke, QC; Élie Boustani, MD; Hollly Witteman, PhD; Claude Richard, PhD; Fatoumata Binta Diallo, PhD, Montreal, QC; Marilou Croteau, MD

Description: Contexte : La gestion optimale des maladies chroniques exige que les patients jouent un rôle actif dans leurs soins. Une des stratégies pour y arriver est d’améliorer les habiletés communicationnelles des patients. La présente recherche vise à décrire et évaluer l’adoption et l’implantation du site web francophone, Discutons Santé, en contexte clinique, et à apprécier l’expérience de son utilisation. Méthode : Devis : Une étude de cas multiples. Sites : Trois UMF-GMF du Québec. Participants : Cinq professionnels de la santé et cinquante patients par clinique. Les critères d’inclusion des patients sont : 1) âgés de 40 ans ou plus; 2) atteints de deux maladies chroniques ou plus et 3) capacité à naviguer sur Internet. Description du site web Discutons Santé: un site web francophone composé de trois outils (Mes habiletés PIVO; Mes rendez-vous et Mon carnet de Santé) pour aider le patient à optimiser ses visites médicales. Chaque outil s’accompagne de vignettes cliniques audio et d’exemples. La personne est invitée à réfléchir aux problèmes qu’elle désire aborder et à les prioriser. Un sommaire de la visite du site est généré automatiquement et peut être partagé avec le clinicien. Instruments : Des questionnaires auto administrés et des groupes de discussion auprès des cliniciens et des patients ciblés serviront à recueillir des données sur la portée, l’efficacité, l’adoption, la mise en œuvre des outils dans les milieux cliniques participants. Résultats : Au moment de la présentation, les données sur l’expérience des professionnels à suggérer la visite du site web aux patients éligibles dans le cadre de leur suivi régulier seront disponibles. Aussi, les données sur l’expérience des patients quant à l’utilité perçue des trois outils et leur impact sur la visite médicale seront également présentées. Conclusion : La présente recherche permettra d’identifier les conditions nécessaires pour intégrer l’intervention au suivi habituel des patients en soins de première ligne.

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Discutons Santé: A website to help chronic disease patients and providers engage in productive interactions Marie-Thérèse Lussier, MD, MSc, CCFP, FCFP, Montreal, QC; Claude Richard, PhD, Montreal, QC; Binta Diallo , PhD; Collectif Capsana, Montreal, QC; Fatoumata Binta Diallo, PhD, Montreal,QC; Fatoumata Binta Diallo, PhD, Montreal, QC

Description: Context: Communication interventions directed at patients, including self-learning websites, can increase patient participation, but few are available in French. Communication skills training is part of medical curricula. However, there have been few attempts at concurrent training approaches to improve both patient and health care provider (HCP) communication. The project aim is to develop and validate a French-language website intended to help patients and HCPs engage in productive interactions. Methods: Phase 1: Development of website materials. Patient training is based on Cegala’s PACE model. HCP training is inspired by the Health Beliefs and Transtheoretical models. Many formats are combined: texts, figures, graphs, video and audio excerpts, and interactive exercises. Phase 2: Capsana, a community organization that specializes in production of health education materials, teamed with us to create the website. Phase 3: Validation of website content, relevance, usefulness, ease of use, and intention to recommend it, preceded by 1) observing test users during website exploration, 2) self-administered individual questionnaires, and 3) patient and HCP focus groups to discuss the website strengths and weaknesses. Evaluation of distinct methods to promote the website within primary care (PC) practices followed: 1) passive diffusion, 2) active diffusion: website visit recommendation by either clinic receptionists or PC providers. Results: Validation data reveal that website presentation and content are relevant and useful and that the users intend to recommend its use. Patients suggested adding more instructions to improve navigation. Providers wished a greater number of clinical cases to illustrate the theoretical principles presented. Data from the evaluation of website promotional methods indicate increased patient visits when the HCPs suggested it. Discussion: This is the first French-language website aiming at simultaneously improving both patients‘ and HCPs’ communication in the primary care context. A pilot study to study the implementation of the website in routine primary care practices in three Quebec teaching clinics is under way.

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Exploring the Development of a Canadian Taxonomy of Primary Health Care Mary Byrnes, Toronto, ON; Geoff Ballinger, Ottawa, ON; Tanya Flanagan, Toronto, ON

Description: Context: Construction of taxonomies in health care has become an important feature of health services research, especially for those that want to use data to inform planning and policy. Objective: The objective of this study was to begin to explore whether individual fee codes in two provincial fee schedules could be classified or grouped as primary health care. Most primary health care studies based on patient-level clinician billing data simply focus on physician fee codes billed by general practitioners. However, not everything a general practitioner does is necessarily a primary health care service and some services provided by other specialty clinicians are in fact related to primary health care.

Design: A clinical subject matter expert conducted a comprehensive review of fee codes from two Canadian jurisdictions to identify a set of codes in each province that were primary health care services. A small working group was then established to provide jurisdictional subject matter expertise and feedback on the development of decision rules. The fee codes were subject to these decision rules as well as to a set of validation processes intended to capture codes that were not included in the initial grouping. Results: The study identified 64 fee codes out of a total of 3079 fee codes that were “clearly primary health care” in one province, and 89 fee codes out of 4196 that were clearly primary health care in the other province. Conclusions: The results of this study suggest that individual fee codes in two provincial fee schedules can be classified or grouped as primary health care. Further work is required to assess the validity of this methodology as a suitable taxonomy of primary health care within and across jurisdictions. Additional analytical work is recommended to understand how the grouping could be used as a tool to aid primary health care research.

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Examining the Relation Between the Type of Record System Used and Time Spent in Patient Care Dragan Kljujic, MA (Psych), Mississauga, ON

Description: Context: Electronic medical records (EMRs) provide health care teams with a holistic perspective of their patients’ health, and can enhance communication among team members and between them and their patients. Moreover, EMRs improve the health care system efficiencies (eg, reduce the ordering of duplicate tests). This could provide family physicians with more time to focus on patient care. Objectives: 1) To identify the percentage of family physicians using electronic records, paper charts, and a combination of electronic and paper charts; 2) To compare these physicians in terms of hours spent providing patient care. Design/method: The presentation will use FP data from the 2007, 2010, and 2014 National Physician Survey (NPS). The NPS is an ongoing collaborative initiative led by the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada. The surveys were sent to all practising physicians in Canada; all physicians had the opportunity to complete the survey, with voluntary participation. Data was then weighted to produce estimates of the total population of physicians in Canada. Results: The percentage of family physicians using electronic records exclusively has increased from 12% in 2007 to 22% in 2010 and 42% in 2014. In contrast, the percentage of family physicians using only paper charts has decreased from 63% in 2007 to 41% in 2010 and 20% in 2014. In 2007 and 2010, physicians using paper charts or a combination of paper and electronic charts spent an average of 40 hours weekly providing patient care. On the other hand, those using electronic records indicated an average of 44 hours in 2007 and 43 hours in 2010. Similarly, in 2014, FPs using paper charts or a combination of paper and electronic charts reported 36 and 37 hours on patient care, respectively, while those using electronic charts indicated 40 hours of patient care. Conclusion: Family physicians who are using electronic charts exclusively seem to have more time to focus on providing patient care than those using a combination of electronic and paper charts, or paper charts only.

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Analyzing Health Data Across Care Systems: The NYFHT-NYGH Joint Data Warehouse

Michelle Greiver, PhD, MSc, CCFP, FCFP, Toronto, ON; Frank Sullivan, PhD, FRCP, MRCGP, FRCGP, MRCP, Toronto, ON; Babak Aliarzadeh, MD, MPH, Toronto, ON; Karim Keshavjee, MD, CCFP, Toronto, ON; Michael Wood, Toronto, ON; Michael Wood, Toronto, ON; Kevin Katz, MD, FRCP, Toronto, ON; Eugene Wong; Sumon Acharjee, Toronto, ON; John A. Aldis, CPA, CA, Toronto, ON; Rita Reynolds, Toronto, ON; Kimberly Wintemute, MD, CCFP, Toronto, ON, Susan Griffis, RN, MA, DBA, CHE, Toronto, ON

Description: Context: Complex patients frequently transition between primary care and hospital. We need to identify these patients and know more about them so that care can be organized to best meet their needs. However, the necessary data are found in multiple unconnected electronic systems and the information to enable identification and analysis is often not available to care providers. Objective: To build an integrated hospital–primary care data warehousing system. Design: The processes undertaken were 1) survey of the literature on data for care transitions, 2) stakeholder engagement and joint data warehouse design process (including governance, privacy infrastructure), 3) trial linkage of patients from the primary care EMR database and the hospital’s clinical database, 4) system architecture and feasibility assessment, and 5) generation of the demonstration database. Participants: North York General Hospital (NYGH) and North York Family Health Team (NYFHT). Intervention: We interviewed key stakeholders from primary care, hospital, and regional oversight organizations.These included clinicians (MD, RN, pharmacist, etc.), managers, data analysts, hospital leadership (CEO, COO, CFO), lead physicians, patients, privacy experts, and information services and decision support personnel. An initial slide presentation described key elements underlying a data warehousing system, followed by iterative changes based on informant feedback. We undertook a trial match of chronic obstructive pulmonary disease and congestive heart failure patients in the primary care EMR database with the hospital database to demonstrate feasibility. Results: There was agreement and strong support to move forward with design and implementation from clinicians and from senior management. In total, 1650 patients with chronic obstructive pulmonary disease (3% of population) or congestive heart failure (1% of population) were identified in the primary care EMR database. Data were linked and we determined that 78% of those patients had been seen in the hospital at least once, and 24% had had at least one in-patient admission in the past three years. Seven per cent of medical admissions in the past two years at NYGH were patients at NYFHT. Ten per cent of high-risk admissions (Hospital Admission Risk Prediction score >8) were NYFHT patients. Conclusions: A joint data warehouse system appears to be feasible. High-risk patients jointly managed by a family health team and hospital can be identified and studied.

546 Using EMR-Based Search Algorithms to Assess Primary Health Care Service Use and Costs for People Living With HIV

Anjori Pasricha, MD, MSc, Toronto, ON; Andrew Pinto, MD, CCFP, FRCPC, MSc, Toronto, ON; Samy Mekhail, MD, MSc, Toronto, ON; Gordon Arbess, MD, CCFP, Toronto, ON

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Context: With effective antiretroviral therapy, HIV is now increasingly managed as a chronic disease in the primary care setting.

Previous research suggests that the cost of providing care to people living with HIV is high. Electronic medical records (EMRs) provide a unique opportunity to evaluate costs of care. No formal analysis of HIV-related health care utilization and costs using EMR search algorithms has been completed in Canada. Objective: To use EMR-based search algorithms to quantify contact with health care professionals for people with HIV and to estimate the associated cost of care. Setting: St Michael’s Hospital Academic Family Health Team (FHT) serves approximately 1400 patients living with HIV. Design: This study will be a retrospective chart review applying previously validated EMR search algorithms to estimate health service use and cost of care for patients living with HIV. Participants: All adults over the age of 18 years with a diagnosis of HIV, engaged in care between January 1, 2014, and December 31, 2014, will be included. We will exclude patients who receive HIV care (defined as viral load testing and monitoring) in an alternative care setting (eg, infectious disease specialist). Instrument: We will extract data from the St Michael’s Hospital FHT EMR software (PS Suite). Outcome measures: Outcomes of interest will include the number of patient encounters with health care professionals, associated costs based on billings and allied health professional salaries, and health outcomes. Results: Health care utilization (number of encounters with health care professionals) and related costs will be calculated using health insurance claims for physicians. For non-physicians, costs will be estimated based on available data on allied health professional salaries. Conclusions: This study will provide valuable information on the cost of care for people living with HIV, utilizing EMR-based search algorithms to assess resource use in a primary care setting. In addition, the results of this study will shed light on the relationship between costs of care and health outcomes to better understand the factors that impact HIV-specific resource use in primary care.

Menopause-specific Quality of Life Questionnaire (MENQOL) Dissemination and Use: A scoping review

Jacqueline Lewis, MD, CCFP, MSc, FCFP, Calgary, AB; Beate Sydora PhD Edmonton, AB; Hilary Fast BSc Edmonton, AB; Nese Yuksel PharmD Edmonton, AB; Sandra Campbell MLSc Edmonton, AB; Susan Ross PhD Edmonton, AB

Description: CONTEXT: The Menopause-specific Quality of Life questionnaire (MENQOL™ & derivative MENQOL-Intervention™) are patient reported outcome (PRO) measures developed in a Canadian primary care setting and published before there was close attention to intellectual property rights. OBJECTIVE: The purpose of the scoping review is to determine the extent of worldwide use in 1996-2012 inclusive publications and to assess researcher and clinician fidelity to item and domain integrity, scoring and analysis strategy, and publication reporting of pertinent questionnaire characteristics. DESIGN: comprehensive scoping review. INCLUSION: All English and non-English papers using MENQOL as an investigative measure. METHOD: The scoping exercise systematically searched 13 biomedical and clinical databases using ‘menqol’ as a search term. Review articles, conference abstracts, proceedings, dissertations, and incomplete trials were excluded. Google Scholar was searched for ‘grey’ literature. Two independent reviewers extracted data reflecting study design, intervention, sample characteristics and MENQOL questionnaire version, recall period, questionnaire modification, analysis detail and language of questionnaire delivery. Data analyses included categorization and descriptive statistics.

RESULTS: Data extraction identified 957 records of which 166 papers met inclusion criteria. Studies were performed in 38 countries, with MENQOL translated into 30 languages in addition to 18 known professional translations. To date, designs include surveys (71), RCTs (65 ), experimental trials (27), pilot studies (10), psychometric evaluations (6), and case reports (3). Interventions studied hormonal (30), non-hormonal (13) and complementary drugs (20), and physical (20) and psychological (16) treatments. The majority of papers (125) report questionnaire version but not recall period. Fifteen papers explicitly report modified items. CONCLUSIONS: The MENQOL outcome measure contributes evidence to evaluate a number of interventions used in primary care menopause management. Its research use has steadily increased in countries and languages unknown before this comprehensive review. The original lack of license and limited contact between researchers and developers may have permitted unexpected alterations, use of unofficial versions, informal or duplicate translations, and misunderstandings of item intent, especially related to translation or cultural adaptation.

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Evaluation of a Distributed Health Research Methods Course for Family Practice Residents Brian Ng, MD, CCFP, FCFP, CCFP (EM), Vancouver, BC; John-Jose Nunez, BSc, Vancouver, BC; Evelyn Cornelissen, RD, PhD, Kelowna, BC; Ruth Elwood Martin, MD, CCFP, FCFP, Vancouver, BC

Description: Context: Primary health care providers often lack the skills to develop research proposals from clinical questions. Most family medicine residency programs do not provide instruction on research methods. At the University of British Columbia, we developed a Distributed Health Research Methods Course (DHRMC) to address this gap. Objective: To investigate the effect of the DHRMC on the research knowledge, skills, and attitudes (KSA) of family practice residents. Design: Cohort study. Instruments: 1) A crosssectional 25-item survey to assess research KSA. Participants will enter their survey responses in Fluid Survey. Open-ended qualitative responses will be analyzed using content thematic analysis for recurring themes. Closed-ended quantitative responses will be analyzed with simple descriptive statistics using frequencies. Associations between variables will be examined using cross-tabulations and Chi-square analysis. 2) Residency program records will determine number of prizes awarded for resident research projects.

Setting: UBC family practice residency program. Participants: First- and second-year family practice residents across 16 teaching sites.

Main outcome measures: 1) Improved research KSA for residents whose teaching sites participated in the DHRMC, compared with research KSA of residents whose teaching sites did not participate in DHRMC. 2) Increased numbers of prizes awarded for resident research projects in intervention group compared with control group. Results: Since September 2013, 111 (of a total of 320) UBC family medicine residents have enrolled in DHRMC, providing sample sizes of 111 and 209 for intervention and comparison groups, respectively. High response rates are anticipated because all residents will be surveyed in one location during Resident Research

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE Days in June 2015 and June 2016. Findings of this work-in-progress will be presented at CFPC's Family Medicine Forum. Research ethics board certificate is pending. Conclusions: We anticipate that the effect of DHRMC will be improved self-reported research KSA, and increased numbers of prizes for research projects, among family practice residents.

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Needs Assessment for Point-of-Care Ultrasonography Training in a Canadian Family Medicine Residency Program Pierre Robichaud, MD, Ottawa, ON; David Gruber, MD, Ottawa, ON; Douglas Archibald, PhD, Ottawa, ON; Michael Y. Woo, MD, CCFP (EM), FCFP, RDMS, Ottawa, ON; David Gruber, MD, Ottawa, ON; Douglas Archibald, PhD, Ottawa, ON; Michael Y. Woo, MD, CCFP (EM), FCFP, RDMS, Ottawa, ON

Description: Context: Point-of-care ultrasound (PoCUS), defined as “ultrasonography brought to the patient and performed by the provider in real time,” is becoming rapidly recognized and adopted as a valuable tool across many fields of medicine. Formal bedside ultrasound training is a prominent component of several non-family medicine residency programs. However, despite its availability, wide applicability, and rapid learning curve, PoCUS has yet to be adopted in many Canadian family medicine residency programs. Objective: To assess the perceived need for PoCUS training in a Canadian family medicine residency program. Design: An anonymous survey was distributed online to family medicine residents. The survey assessed demographic information, baseline exposure to PoCUS, perceived utility of PoCUS, and the perceived need for PoCUS training as part of a family medicine residency curriculum. Target population: PGY-1 and PGY-2 residents at a Canadian family medicine residency program. Main outcome measures: Perceived utility of PoCUS and perceived need for PoCUS training as part of family medicine residency training. Results: Despite limited exposure, most respondents perceived PoCUS as a useful clinical tool and perceived a need for PoCUS training in their residency. More than three-quarters of residents anticipate they would regularly use PoCUS in their clinical practice if they were adequately trained and competent. There was no clear correlation between main outcome measures and the respondents’ training environment, anticipated clinical practice environment, or baseline exposure to PoCUS. Conclusions: Our study demonstrates that the residents of our family medicine training program perceive PoCUS as a useful clinical tool and have a significant interest in accessing formal PoCUS training during their residency.

550 “How Is It for You?” Residents’ and faculty experience with a new family medicine competency-based curriculum

Maria Palacios, DDS, MSc, PhD, Calgary, AB; Keith Wycliffe-Jones, MB ChB, CCFP, Calgary, AB; Sonya Lee, MD, CCFP, FCFP, Calgary, AB; Vishal Bhella, MD, CCFP, Calgary, AB

Description: Context: The University of Calgary Family Medicine (FM) residency program introduced a new "Triple C" competency-based curriculum in 2012. This presented an opportunity to study in depth the impact of such a major change on both faculty and residents. Methodology: Semistructured interviews were completed with 10 second-year FM residents and 16 faculty involved in the introduction of the new curriculum. Study participants were selected using a purposeful sampling method. Interviews were recorded and subsequently transcribed verbatim for thematic analysis. Results: The analysis revealed a wide variation in residents’ and faculty members' understanding of the elements of a Triple C competency-based curriculum. Study participants identified issues relating to the delivery of quality, consistent, and equitable learning experiences in a large residency program. Scheduled learning experiences with non-physician health care professionals appeared to be less valued by residents than were experiences with physicians, and significant challenges around providing experience of continuity of care were also identified, especially in larger academic teaching clinics. Integration of residents into the FM clinics was better and continuity of supervision throughout the training was improved. A potential trade-off with experiences in inpatient care and acute care settings was identified. Some challenges relating to clinical opportunities and program delivery were attributed in part to program expansion as opposed to curriculum change. Conclusions: For a new curriculum to be successful, an ongoing process of evaluation and monitoring of learning experiences is essential. Despite some deficiencies and implementation challenges identified by study participants, residents and faculty both acknowledged that these were expected and were willing to commit to and engage with the new curriculum. Understanding how the Triple C curriculum impacted our learners and faculty provided essential feedback to curriculum developers, and enhanced our ongoing processes of quality assurance and improvement within the program.

551 Survey of Family Medicine Residents’ Comfort With Home Care Core Competencies: Can a longitudinal curriculum yield improvements?

John Kirk, MD, CCFP, FCFP, Montreal, QC; Fanny Hersson-Edery, MD, CCFP, Montreal, QC

Description: Context: The exposure of family medicine residents to home care teaching is recommended by the College of Family Physicians of Canada.

In developing our longitudinal home care teaching program we sought to create core competencies for the teaching of family medicine residents. Objective: To determine if a structured home care teaching program can increase the comfort of family medicine residents in acquiring new home care competencies over the span of their residency training. Design: We performed a teaching program evaluation using a survey design. Outcome measures: The family medicine residents responded to an online survey. Questions used a Likert scale to assess their level of comfort with selected core competencies in home care at 0,12, and 18 months of training. Participants: A cohort of 23 family medicine residents training at the Herzl Family Practice Clinic teaching unit from 2013 to 2015. Findings: As the residency progressed, a majority of residents experienced an increase in comfort level with core competencies such as adapting the physical exam to the home setting. However, their comfort with with other competencies, for instance, assessing patient competency in the home, did not improve.

Conclusions: Family medicine residents exposed to home care practice longitudinally during their residency training can develop increasing comfort with selected core competencies. This improvement was not observed for certain competencies, perhaps because of increased complexity or a lack of exposure. These findings might have important implications for the development and refinement of a family medicine home care teaching program.

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Training on Underserved Population: From a student project to a part of the medical curriculum Christine Ouellette, Montreal, QC; François Venne, Montreal, QC; Samantha Coulombe, Montreal, QC

Description: Context: So-called “underserved populations” are those whose socioeconomic, cultural, or legal context prevents them from benefiting from

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the opportunities afforded to the rest of society. These populations face significant stigma from health care providers, who often fail to grasp this context because of a lack of exposure to these populations during their training. This stigma, in turn, might lead to delivering lower quality care to these patients. Objectives: To increase medical students’ understanding of various underserved communities and social issues surrounding them. Medical students will then be more prepared to manage patients by addressing the specific needs of these communities. Furthermore, we aim to stimulate students' interest in working with these communities.

Methods: Our extracurricular project, the INcommunity immersions, was founded by medical students, who put together a onemonth summer immersion program in four communities that are thought to suffer from a lack of understanding by health care providers: the “Inner-city populations,” “Migrants,” “Aboriginals,” and “Offenders.” In partnership with local organizations, students learned about the challenges faced by the community in which they were immersed through internships, training sessions, reflective writing, and group discussions. In addition, wanting to bring the INcommunity concept to a wider audience, medical students collaborated with the University of Montreal's faculty of medicine in order to have all students exposed to underserved populations.

Classes were added to the first- and second-year curricula, and a one-week immersion session was implemented in the last two years of medical school. Outcomes: After four editions of the INcommunity immersions, more than 75 students participated in a four-week extracurricular immersion and reported a deeper understanding of the issues faced by underserved populations. For the first time at the University of Montreal, a whole class (graduating in 2015) experienced a full week dedicated to underserved population and social determinants of health. To further investigate the evaluation of our projects, an impact assessment will be performed, starting with next summer’s participants. Conclusion: Through these immersion projects, we wish to fight stigma, advocate for underserved populations, and train medical students to become better doctors, by socially and culturally adapting the care they provide to these communities.

Panel Management Curriculum to Teach Emerging Competencies for Family Medicine Residents

Sohil Rangwala, MD, CCFP, Ottawa, ON; Douglas Archibald, PhD, Ottawa, ON;Anne Balkissoon, MD, Ottawa, ON; Elizabeth Muggah, MD, CCFP, Ottawa, ON; Sharon Johnston, MD, CCFP, Ottawa, ON

Description: Context: Panel management (PM) is a new approach to care where providers proactively address the health of their entire patient population (or panel) rather than react to health issues presented at visits. Curriculum guides to teach this new approach are scarce.

Objective: To develop and evaluate a PM curriculum for family medicine residents to improve collaboration, communication, practice management, and care coordination; to enhance resident experience in patient ownership and continuity of care; to strengthen teaching and quality of care (chronic disease management, health promotion, and disease prevention). Design: Pilot project using a mixed-method program evaluation approach. Setting: A single academic training site for family medicine in Ottawa, Ontario. Participants: Seven first-year and eight second-year family medicine residents. Intervention: Residents were assigned a panel of 50 patients meeting pre-established criteria to ensure diversity in age, gender, and morbidity. Residents received dedicated PM time to review their panels and target specific activities, applying knowledge from evidence-based literature. PM activities were recorded in activity logs, and communicated to preceptors as well as to the allied health team through the electronic medical record. Outcome measures: An activity log was developed as both a teaching and an evaluation tool for formative feedback.

Ongoing resident evaluation and a robust program evaluation were embedded in the curriculum to enable iterative adaptation and improvement. An assessment instrument of panel management competencies was developed for supervisors to evaluate residents’ skills in PM during quarterly reviews, using information from chart audits, resident activity logs, and resident self-reflection surveys.

A validated resident self-evaluation instrument was used to assess competencies in collaborative care. Conclusions: A PM curriculum provides an opportunity to teach and evaluate key clinical competencies for family medicine residents including collaboration, practice management, and care coordination, while promoting patient ownership and continuity of care.

555

What Is the Usability of a Mobile Application to Prepare Residents for Their Board Examinations?

Diana Ramos, MD, L'ile bizard, QC; Roland Grad, MD CM, MSc, FCFP, Montreal, QC; Alenoush Saroyan, MEd, PhD, Montreal, QC

Description: Context: We developed a mobile app for residents to assist preparation for their certification examinations. Our vision is that interested parties—eg, Departments of Family Medicine—will promote the app as a study tool, and that locally, expert teachers will participate by adapting the clinical information in the app for their residents. The app (called IAM) was developed for tablet computers, iPhone, and Android devices. The IAM presents information on the “99 Priority Topics” at four levels: priority topics, their key features, clinical information on key features, and hyperlinks to online information. In addition the app contains a validated questionnaire for residents to provide feedback on this information. By means of alerts, residents can become aware of one topic per week. Objective/design: To better understand residents' experiences with the IAM app and its usability through a qualitative descriptive study. Participants: Twenty family medicine residents from McGill University consented to this six-month study in October and November 2014. Method: Data collection is performed by logging of page hits, whenever a page in the app is opened by a resident. Usage data will be analyzed from October 2014 to May 2015. Individual open-ended semistructured interviews have already been conducted, and a final interview is planned for May 2015 following the certification examination. Based on log files of app use, we will interview three types of residents (never users, former users, and users of the app). Inductive thematic analysis will be employed to classify data into codes and themes. Reliability of data coding will be assessed. This process will lead us to develop naturalistic generalizations to represent the data. Expected findings: This study is in progress. We will present our findings in a table by type of user according to emerging themes and corresponding excerpts such as barriers—notifications—alert overload. Study findings will help to improve the app.

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To What Extent Do Residents Use an App for Self-Learning Related to the 99 Priority Topics?

Stefan Kegel, MD, CCFP, Toronto, ON; Roland Grad, MD CM, MSc, CCFP, FCFP, Montreal, QC; Inge Schabort, MB ChB, CCFP, FCFP, Hamilton, ON

Description: Context: We developed a mobile app as a study tool for residents, by combining the concept of spaced education with smartphone technology. Objective/design: In the context of a usability study, we offered a smartphone tool (the IAM app) to residents, for self-learning related to the 99 priority topics. We sought to examine use of the IAM app and to determine the most read topics, the extent of app use by residents, and the effect of weekly alerts on topic readership. Participants: In all, 146 residents (64 second-year and 82 first-year) from the McMaster Family Medicine Program were consented in December 2014 and January 2015. Intervention: Page tracking: Whenever a page in the app was opened by a resident, the tracking system would log this event. Data were analyzed from December 24, 2014, to March 2, 2015.

Results: Of the 146 residents who consented, 86 (59%) used the IAM app during the study period. We documented a mean number of page hits of 40.3 per resident (range 1 to 473). The number of users declined from 76 to 60 after the first study month; however, the number of hits per user per month increased from 26.6 to 28.9. The most popular topics were Abdominal pain (386 hits), Asthma (301 hits), and Anemia (200 hits). There were 5 topics that did not have any hits: Chest pain, Dyspepsia, Dysuria, Elderly, and Immunizations. We sent alerts on topics 1 to 7 to prompt residents. For these topics, 18.3% of total hits were logged within 5 days of the alert. Conclusion: In the first 60 days, use of the IAM app was relatively high and likely influenced by the novelty effect. The alert system seemed to prompt a fair user response. In the next cohort of residents, the app will serve as a platform for a study of the effectiveness of alert messages prompting the reading of priority topics.

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Targeting Communication Problems: Knowledge or process issue

Dawn Martin, Dawn Martin MSW RSW MEd PhD, Toronto, ON; Sue Glover Takahashi, MA, PhD, Toronto, ON

Description: Background: Problems with communication in the clinical encounter during postgraduate training are frequently identified. Clarity on the type of problem(s) experienced helps guide the selection of resources, sequence of intervention and the educational strategy used.

Unravelling whether it is content (knowledge), process (skills) or a perceptual (attitude) issue can be challenging. Methods: A pilot study was done retrospectively exploring Board of Examiners (BOE) University of Toronto, Office of Postgraduate Medicine cases where residents were identified as needing additional support from a Communication coach. Cases were deconstructed to identify problem type and educational interventions using multiple assessment strategies. Results: The most frequently identified assessment strategy was role play with standardized cases. Content knowledge was assessed using the provided answer key whereas process and perceptual issues were assessed using Martin’s Communication Map (a conceptual map of an organized, patient-centered clinical encounter). When the strategies were used together, it became evident whether the communication problem was related to content, process or perceptual. Clearly identifying the problem made it possible to sequence the educational intervention and establish effective educational interventions. For example, a disorganized approach might be due to knowledge gaps or to the absence of an organizing framework. The former would be addressed with a targeted reading program whereas the latter would focus on providing a framework. Knowledge gaps need to be addressed before process problems.

Conclusion: Communication problems take many forms. Clearly differentiating and correctly characterizing the problems helps determine the educational interventions, learning sequence and strategies to provide targeted remediation.

558

Research and Quality Improvement in Postgraduate Family Medicine Residency

Kelsey Klages, MSc, London, ON; Fred Ross, BACS, CHRP, London ON; Eric Wong, MD, MClSc(FM), CCFP, London, ON

Description: Context: To stress the importance of research and quality improvement in family medicine, postgraduate programs will need to implement innovative curricula. Literature suggests experiential learning as preferred when training learners. Objective: A transformed resident project curriculum focusing on research and quality improvement was designed and implemented. Design: Program evaluation. Participants: Western University family medicine residents. Intervention/instrument: The curriculum was set after literature review, environmental scan of other programs, and committee meeting discussions. With a focus on active participation, curriculum deliverables included the Institute for Healthcare Improvement's Improvement Capability modules, a Model for Improvement quality improvement proposal or research proposal, and a final report. Residents had access to a trained expert, resources, meetings, and templates. Department- and university-specific resources were aligned to advance the curriculum. Outcome measures: Improvement Capability module data, Quality Improvement Confidence Instrument, Quality Improvement Proposal Assessment Tool, final project assessment tool, lecture assessments, curriculum evaluations, and program committee informal discussions. Challenges in creating and implementing the curriculum were described along with resident project topics, challenges, and successes. Results: Improvement Capability scores ranged from 90% to 95%. Residents completing the new curriculum had higher confidence in performing quality improvement than had the previous year's residents. Percent agreement for evaluative tools were high. Residents were satisfied with content delivered during resident project lectures. The reformed curriculum positions quality improvement and research on opposite ends of the same scholarly inquiry spectrum and this approach appeared effective for researchinvolved stakeholders and early adopters. Other stakeholders were concerned the approach focused on quality assurance, highlighting the need for additional training in quality improvement. Residents completing research largely worked alone and projects involved surveys and chart reviews. Quality improvement projects were largely completed in groups and the projects involved patient care (vaccination rates, appropriate prescription, screening rates) and documentation. Residents found it challenging to collect data from the electronic medical record, and the data collected often had accuracy issues. Project proposals often involved testing large tests of change instead of small tests of change through plan-do-study-act phases. Discussion/conclusions: Research and quality improvement might become a priority through practice settings with strong scholarly inquiry culture and departmental, university-wide, and community supports.

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Resident Selection in Canada: What do program directors think about best practice recommendations?

Keith Wycliffe-Jones, MB ChB, FRCGP, CCFP, Calgary, AB; Glen Bandiera, MD, MEd, FRCPC, Toronto, ON; Nick Busing, MD, CCFP, FCFP, Ottawa, ON; Sandra Banner, Ottawa, ON; Anurag Saxena, MD, FRCPC, Saskatoon, SK; Matt Raegele, Ottawa, ON

Description: Introduction: Residency selection processes across Canada are often poorly understood by applicants and their advisers, resulting in

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significant stress and uncertainty. In such a high stakes and competitive environment where there is often perceived inequity, students can become over-focused on maximizing their chances of selection by a chosen program, potentially at the expense of their overall undergraduate learning. Furthermore, residency Program Directors often struggle to identify and implement reliable and valid assessment strategies to optimize match results to their programs. There is an overall need to improve the transparency and fairness of these processes and also to gather information on the current selection processes used across the country in resident selection.

Method: One medical school recently convened a diverse working group to develop a series of 24 best practice recommendations around resident selection. We invited approximately 600 Residency Program Directors in Canada, including all Family Medicine Program Directors, to complete an online survey investigating their i) level of agreement with the recommendations ii) thoughts on the feasibility of implementing each recommendation nationally and iii) the current level of compliance with each of the 24 recommendations in their Program. Respondents were also asked to provide narrative comments on each recommendation. Likertscale scores and narrative responses will be analysed quantitatively and thematically. Results: Program Directors’ levels of agreement, impressions of implementation feasibility and current level of compliance will be presented for each recommendation, as well as a thematic analysis of the narrative comments by program type. Conclusion: This study will provide valuable baseline information on current residency selection processes across Canada and will also provide important feedback from Program Directors on their levels of support for implementation of each of the best practice recommendations.

Anxiety, Depression, and Frequent Binge Drinking Among Medical Students

Nora Magyarody, MD, MSc, CCFP, Kingston, ON; Eva Purkey, MD, MPH, CCFP, Kingston, ON

Description: Context: Medical school is a time of significant stress for future physicians, and students’ mental health frequently deteriorates over the course of training. It has been suggested that students under psychological stress might use alcohol as a means of coping.

Objectives: 1) To quantify the prevalence of anxiety, depression, and frequent binge drinking among Queen’s medical students across their four years of medical training. 2) To assess the relationship between anxiety, depression, and frequent binge drinking among Queen’s medical students who drink alcohol. Design: Cross-sectional e-survey, from January 18 to February 14, 2015. Target population: In all, 400 students attending Queen’s School of Medicine, a medical school at Queen's University in Kingston, Ontario, Canada. Instrument: Anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), respectively. Binge drinking was defined as consuming 4 or more standard drinks in one sitting for women, and 5 or more standard drinks in one sitting for men. Outcome measures: The variables of primary interest were generalized anxiety disorder (GAD-7 score ≥ 10), major depression (PHQ-9 score ≥ 10), and frequent binge drinking (binge drinking at least twice in the last two weeks). Statistical techniques included calculations of frequencies, means, and Tukey tests. Findings: There were 82 (20.5%) respondents, with 76 (19.0%) providing valid data. Overall, 15.8% of respondents were found to have generalized anxiety disorder, and generalized anxiety disorder was most prevalent among third-year students (27.8%). Similarly, the overall prevalence of major depression was 14.5%, and was most common among third-year students (22.2%). The overall prevalence of frequent binge drinking was 28.9%, and was most common among first-year students (40.9%). Among drinkers, mean GAD-7 and PHQ-9 scores did not differ significantly between frequent and non-frequent binge drinkers (P = .679 and P = .537 respectively). Discussion/conclusion: This study suggests that anxiety, depression, and frequent binge drinking might be highly prevalent among Queen’s medical students.

No significant relationship was identified among the symptoms of anxiety and depression and drinking frequency. There is a strong need for supportive programming for medical students with anxiety and depression, and further research regarding the risk factors for frequent binge drinking among medical students.

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Personal Health Care Practices in Residency: A cross-sectional survey Laura Vance, MD, Kingston, ON; Kelly Howse, MD, CCFP, Kingston, ON

Description: Context: Residency training can be a very stressful time and might precipitate or exacerbate both physical and mental health problems. Research has shown that many residents do not have an easily accessible family physician and might turn to colleagues for prescriptions or ignore their personal health concerns altogether. Objectives: This study examines the personal health practices of Queen’s University residents and the factors affecting residents' health behaviour. It also makes comparisons to documented practices of a similar group of Queen’s residents over a decade ago, to speculate whether the recent increased emphasis on resident wellness has translated into objective changes. Design: Cross-sectional survey. Participants: Queen’s University residents across all years of all postgraduate programs; N = 113 survey respondents. Instrument: An electronically distributed survey, modeled on a similar study from 2001, gathered important demographic data, as well as participants’ self-reported actions when faced with two hypothetical health scenarios (pneumonia and depression). Results: Among respondents, 57% have a family doctor within one hour's travel; 29% must travel longer than one hour; and 14% have no family physician. Residents with children are more likely to have a local family physician. Those with a chronic illness or mental health condition, or who regularly take prescription medications, are not.

Most residents would seek help appropriately in response to a physical health scenario but not necessarily in response to a mental health one. Of the respondents, 30% report they would confide in another resident when faced with depression, as opposed to getting formal medical help or counseling. Conclusion: Overall, a greater proportion of current residents, compared to residents in 2001, have a local family physician and would choose seemingly appropriate courses of action for their physical and mental health concerns. Lack of time and attitudes about needing a physician remain important barriers, and residents might need to be educated

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SCIENTIFIC PROGRAM | WEDNESDAY 11 MERCREDI | PROGRAMME SCIENTIFIQUE about encouraging colleagues in distress to seek formal help. Conceivably, though, by emphasizing resident wellness over the past decade, some gains have been made in the personal health practices of Queen’s residents.

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Evaluating the Impact of Mindfulness Meditation on Family Medicine Residents' Well-being

Joan Horton, MD, CCFP, FCFP, Calgary, AB; Aliya Kassam, PhD, Calgary, AB; Doug MacLean, EdD, Calgary, AB

Description: Context: Professional competence in medicine requires self-regulation in stressful situations, yet few doctors are taught stress management during their training. The high cost of physician burnout, depression, and loss of empathy has been well documented. Mindfulness-based stress reduction (MBSR) has been extensively studied and found beneficial in medical personnel. Objective: To determine if an adapted program of in-person training and online coaching in mindfulness meditation has an impact on the well-being of family medicine residents.

Design: A convenience sample of family medicine residents self-selected to participate in either the active intervention or the comparison group. The study questionnaire was administered at baseline, after the eight-week intervention, and at 16 weeks. Active participants completed weekly mindfulness meditation practice logs and final evaluations of the program's usefulness and feasibility. Participants: All University of Calgary family medicine residents, N = 179, were eligible. Prior MBSR instruction mandated exclusion. Intervention: A twohour introduction to mindfulness meditation, daily practice using a collection of guided mindfulness meditations, and seven weekly coaching messages via email were given to all active participants. Outcome measures: The study questionnaire consisted of the Copenhagen Burnout Inventory, the Perceived Stress scale, the Prime-MD Depression screen, the Interpersonal Reactivity Index, and the Two-Facet Mindfulness scale. Results: Seven active and 10 comparison participants completed all three questionnaires. Repeated measures ANOVA and independent t-tests revealed borderline significant decreases in Personal and Work-related Burnout after 8 weeks. These regressed to insignificant differences at 16 weeks. Mindfulness was significantly improved in the active group and persisted to 16 weeks (d = 2.07, r = 0.72). The evaluations rated the introduction, recordings, and feasibility highly, but identified fatigue, conflicting schedules, and lack of group time as limitations. Conclusions: This pilot study, the first done with only residents, was limited due to low enrollment and competing demands on residents' free time. The abbreviated mindfulness meditation course had an impact on burnout and improved mindfulness over the 8 weeks of the intervention, but only mindfulness was significantly improved after 16 weeks. Protected program time for stress management skill acquisition might benefit residents' development of professional competence and patient care outcomes.

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Benefit of a Nutrition and Exercise Session to Medical Students in First-Year Courses Riad Al Sabbagh, BSc, Oakville, ON; Riad Al Sabbagh, BSc, Oakville, ON; Jean Hudson, MScCH, MD, FCFP, CCFP, Mississauga, ON

Description: Context: Lifestyle habits such as healthy eating and regular exercise are extremely beneficial when it comes to disease prevention and management. Patients expect physicians to be knowledgeable and competent in discussing nutrition and physical activity; however, the majority of physicians feel ill prepared to do so. Currently there is a clear deficiency in the practical nutrition and exercise education in undergraduate medical curricula and therefore the benefits of introducing a nutrition and exercise session to medical students in firstyear clinical skills courses will be explored. Objective: To review the status of nutrition and exercise education in Canadian undergraduate medical education and to propose a nutrition and exercise session for medical students in first year. Design: A literature search and review of 60 studies. Participants: None. Instrument: Databases used include PubMed, Scopus, Web of Science, and University of Toronto Libraries.

Findings: Nutritional and physical activity education is deficient in undergraduate medical programs in Canada. Because healthy habits take time to develop, it is essential that medical students be exposed to the benefits of healthy eating and regular exercise in their first year. Moreover, the attitude and behaviour of the physician toward nutrition and exercise are indicative of the counseling behaviour of the physician. A physician with a strong understanding and conviction about the benefits of healthy eating and exercise will be significantly more likely to counsel his or her patients. It is therefore in the best interest of undergraduate medical programs to begin teaching their medical students about healthy lifestyle habits early on in the medical curriculum and to provide hands-on training through a session dedicated to nutrition and exercise. Conclusion: It is in the best interest of undergraduate medical programs to begin teaching their medical students about healthy lifestyle habits early on in the medical curriculum and to provide hands-on training through a session dedicated to nutrition and exercise.

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T101025 07:00–08:00

Residency PBSGL Networking Meeting Tom Elmslie, MD, CCFP, FCFP, FRCPC, Ottawa, ON: Linda Mayhew, Hamilton, ON 715A MTCC

Description: Looking for tips for running PBSG sessions in your residency program? Interested in how PBSG can be used to help residents with transition to practice? Or are you a resident who wants to learn more about PBSG? Learn from others across the country who participate in the residency PBSG program. Representatives from the Foundation for Medical Practice Education will be leading this session. Please join us for an open discussion about using PBSG in residency programs. This session provides an opportunity for those involved in residency PBSGL (practice-based small group learning) to interact with and learn from key contacts and other programs across the country.

T101830 07:00–08:00

Mental Health and Addictions Networking Breakfast on Concurrent Disorders in Family Practice Ellen Anderson, MD, MHSc, Sooke, BC; Sharon Cirone, MD, CCFP (EM), FCFP, Toronto, ON 707 MTCC

T102744 07:00–08:00

General Practice Psychotherapy Networking Breakfast Victoria Winterton, MD, CCFP, FCFP, Owen Sound, ON; Chris Toplack, MD, CCFP, FCFP, Wolfville, NS 717B MTCC

Learning Objectives: 1. reflect on the role of psychotherapy in one‘s family practice 2. integrate knowledge of the models of psychotherapy and how these can be applied in family medicine 3. meet and exchange ideas and experiences with colleagues

THURSDAY • JEUDI

Learning Objectives: 1. discuss practice experience in dealing with concurrent disorders 2. create a resource guide for their practice to support patients with concurrent disorders 3. network with other physicians with an interest in improved management of concurrent disorders

Description: During this session we will explore how comprehensive care family physicians can integrate psychotherapy into their practices in a variety of ways. We will review models of psychotherapy and how these approaches can be adapted for family medicine. The role of the therapeutic relationship will be addressed. In addition, participants will be encouraged to reflect on their own practices and will have an opportunity to share ideas and experiences with colleagues.

T103764 07:00–08:00

Panel Discussion on Topics in FP Anesthesia – Networking Breakfast 703 MTCC

Description: Join the CAGA CPFM group to discuss "Challenges Facing the Rural Family Practice Anesthetist". FMF delegates are invited to share their knowledge and expertise in this specific area of interest at the CAGA Networking Breakfast.

T103766 07:00–08:00

Health Care of the Elderly Networking Breakfast 705 MTCC

Description: FMF delegates are invited to share their knowledge and expertise in this specific area of interest at the Health Care of the Elderly Networking Breakfast.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T103866 07:00–08:00

Stories of Hospital Medicine: How do you incorporate hospital medicine into your practice?

Networking Breakfast

Benjamin Schiff, MD, CCFP, Montreal, QC 709 MTCC

Learning Objectives: 1. discuss ways to incorporate hospital medicine into the family physician‘s practice, be it in an urban, suburban, or rural location 2. discuss tools to help maintain competencies in hospital medicine 3. discover ”tricks of the trade” in examples from the practices of colleagues Description: The networking breakfast is being organized to provide an opportunity for family physicians who care for hospitalized patients to meet and share their experiences. The session will open with a brief introduction, to be followed by interactive sharing of personal stories.

T115047 07:00–08:00

Researchers in Education Networking Breakfast 713A MTCC

Description: Please join us for our Fourth Annual Family Medicine Researchers in Education Networking Breakfast to connect with colleagues conducting like-minded research and to share your current and prospective research ideas.

T115054 07:00–08:00

New Teachers Networking Breakfast 715B MTCC

Description: Just starting out in your academic career? Join a group of new family medicine teachers for an informal breakfast, stimulating discussions, and networking opportunities!

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TJ200 08:00–09:30

Keynote: The Gift of Leadership in Health Care / Le don du leadership en soins de santé Sister Elizabeth Davis, BA, Bed, MA, MhSc, LL, St. John‘s, NL Hall FG MTCC

Learning Objectives: 1. appreciate the significant implications of the deceptively simple CFPC motto (In Study Lies Our Strength) for the practice of family medicine in Canada in light of the intense social, political, technological and environmental changes of this time in our history 2. understand what ”study” means for family physicians today as the understanding of health and health care is being transformed in these changing times 3. see in a new way the kinds of ”strength” which family physicians, individually and collectively, must bring to the citizens of Canada who give family medicine its privileged professional status

Sister Elizabeth has served as Assistant Medical Director and Executive Director of St Clare‘s Mercy Hospital in St John‘s, Newfoundland, as well as President and CEO of the Health Corporation of St John‘s. She has served with distinction on national and international organizations including the Royal College of Physicians and Surgeons, the Canadian Institute of Health Information, the National Board of Medical Examiners, the Council of Licensed Practical Nurses, and the Association of Canadian Teaching Hospitals.

Objectifs d‘apprentissage : 1. prendre conscience des implications importantes de la devise du CMFC (L‘étude est notre force), qui n‘est pas aussi simple qu‘elle n‘y paraît, pour la pratique de la médecine familiale au Canada, compte tenu des de l‘envergure des changements sociaux, politiques, technologiques et environnementaux de notre époque 2. comprendre ce que veut dire « étude » pour les médecins de famille d‘aujourd‘hui, à une époque où la compréhension de la santé et des soins de santé fait l‘objet d‘une transformation 3. voir sous un autre angle les types de « forces » que les médecins de famille, individuellement et collectivement, doivent apporter à la population canadienne, apport qui donne à la médecine familiale son statut professionnel privilégié

THURSDAY • JEUDI

Description: Accomplished health care advocate and educator, Sister Elizabeth Davis, Congregational Leader of the Sisters of Mercy of Newfoundland, is recognized for her dedicated work in health policy, advocacy, social justice, and social determinants of health.

She presents a unique and inspiring perspective on the leadership of family doctors and the significant difference they make in the lives of their patients and in advancing health care no matter where they practise.

Description : Éducatrice et défenseure de la santé accomplie, soeur Elizabeth Davis, responsable de la congrégation des Soeurs de la Miséricorde de Terre-Neuve, est reconnue pour sa dévotion envers les politiques en matière de santé, la représentation des intérêts, la justice sociale et les déterminants sociaux de la santé. Elle présente une perspective unique et inspirante sur le leadership des médecins de famille et l‘importante influence qu‘ils ont sur la vie de leurs patients, ainsi que sur la progression des soins de santé peu importe le lieu de pratique.

Soeur Elizabeth a occupé les fonctions de directrice médicale adjointe et de directrice générale de l‘hôpital St. Clare‘s Mercy, à St. John‘s (Terre-Neuve), ainsi que celles de présidente et chef de la direction du Health Corporation of St John‘s. Elle a fait un travail remarquable auprès d‘organismes nationaux et internationaux, notamment le Collège royal des médecins et des chirurgiens, l‘Institut canadien d‘information sur la santé, le Bureau national des examinateurs, le Conseil des infirmières auxiliaires autorisées et l‘Association canadienne des hôpitaux d‘enseignement.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T96493 10:00–10:30

An Approach to Establishing Levels of Intervention in the Hospitalized Patient Benjamin Schiff, MD, CCFP, Montreal, QC 714AB MTCC

Learning Objectives: 1. discuss the legal and ethical factors regarding levels of intervention 2. develop an approach to engaging patients and/or families in discussions around levels of intervention 3. describe some tools used to guide and document level-of-intervention discussions Description: One of the responsibilities of doctors caring for hospitalized patients (in particular “orphan” patients) is determining the appropriate level of intervention while respecting the wishes of the patient and/or family in the context of whatever medical conditions may be present.

This can be particularly challenging when conflicts arise between the treating team and the patient/family. The types of interventions that can be discussed include (but are not limited to) resuscitation, ICU transfer, artificial feeding, antibiotics, and simple IV hydration. In some cases these discussions have taken place prior to the current hospitalization, but in many instances the hospitalization is the first time these questions are being addressed. In this session, I will review some of the legal and ethical aspects regarding determination of appropriate levels of intervention. I will then provide some guidance with respect to the process of establishing the level of intervention, specifically how to approach patients and/or families, with whom to discuss, when to discuss, and what to discuss. Finally, I will discuss the policy for determining levels of intervention currently in place at my hospital, including the form we use, how it has evolved over time, and the recommended approach to conflict resolution.

T99995 10:00–10:30

Ionizing Radiation and Health Dale Dewar, MD, CCFP, FCFP, Wynyard, SK 717A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe ionizing radiation 2. guide patients in the appropriate mitigating response to medical, environmental, or accidental exposure to ionizing radiation Description: This session builds definitions of ionizing radiation through an open discussion with participants. Participants will learn about the history of X-rays and how they affect cellular structures – why we use lead aprons and other changes in their uses. More specifically, they will see exactly how ionizing radiation causes cellular damage and how the damage might affect the entire patient. Examples of environmental and clinical exposure to each type of radiation will be given as well as the degree of exposure. Physicians will be able to improve their understanding of and rationalization of patient exposures to X-rays, CT, PET, and the host of other scans as well as the use of ionizing radiation in cancer treatment either from external use or from implantable permanent or temporary devices (brachytherapy). Information on the manufacture and transportation of medical radiopharmaceuticals will also be discussed. Inadvertent environmental exposure such as from nuclear power plant accidents or uranium mining tailings will be discussed along with the means by which physicians should (or should not) offer mitigation. We can briefly cover controversial topics such as nuclear power plant disposal, transportation of nuclear wastes, West coast exposure to Fukushima radiation, and current environmental standards.

T100521 Childhood Mental Health Problems: When should family physicians worry?

10:00–11:00 Alice Charach, MD, MSc, FRCPC, Toronto, ON; Suneeta Monga, MD, FRCPC, Toronto, ON; William J. Watson, MD, CCFP, FCFP, Toronto, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. identify key features of preschool children who require assessment for common mental health problems (disruptive behaviour and anxiety) 2. utilize a brief parent report questionnaire to evaluate functional impairment in preschool children due to mental health problems 3. recommend and demonstrate a parenting intervention to assist with management of the mental health problems identified in the office setting Description: Childhood mental health problems such as temper tantrums, disruptive behaviour, and separation anxiety are expected in preschool children, but when is it too much? Ten to fifteen per cent of preschool children have diagnosable mental health problems. Symptom presentations of common psychiatric disorders in preschool children are similar to those in older children, yet many families of young children who could benefit from parenting interventions do not receive them. What is the role of the family practitioner in identifying children and encouraging parents to accept treatment? This workshop will utilize interactive small-group case discussions to highlight the key features of disruptive behaviour and extreme anxiety that may signal clinically significant disorders. Clinical tools such as the brief parent report behavioural questionnaires, as well as management strategies and resources, will be reviewed and demonstrated.

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T101079 10:00–10:30

Techniques for Management of Symptoms of PTSD Victoria Winterton, MD, CCFP, FCFP, Owen Sound, ON; Chris Toplack, MD, CCFP, Wolfville, NS 701AB MTCC

Learning Objectives: 1. identify when a specific intervention to manage symptoms of PTSD is required in the office setting 2. practise and be able to demonstrate three techniques for managing emotional distress 3. apply three techniques for managing emotional distress both in the office setting and elsewhere Description: Post-traumatic stress in its various presentations is a common problem in family practice, manifesting as both physical and emotional distress. Patients experience a variety of symptoms, and often will exhibit distress in the office setting and describe certain experiences of distressing symptoms in their daily life. In this session we will learn three simple techniques that a family physician can use both as an intervention in the office and as a strategy patients can use on their own. These techniques include grounding, managing a flashback, and an intervention to deal with high anxiety.

Victoria Winterton, MD, CCFP, FCFP, Owen Sound, ON 701AB MTCC

Learning Objectives: 1. recognize how non-pharmacologic factors influence antidepressant medication effectiveness, and therefore outcome, in treatment of depression 2. define and identify specific factors that influence both placebo and ”nocebo” effects 3. review specific approaches in prescribing antidepressants that will improve response Description: Family physicians treat the majority of depressive illness in Canada and provide the majority of prescriptions for antidepressant medications. Both pharmacologic and psychologic factors influence the effectiveness of antidepressant medication and therefore influence outcome in the treatment of depression and related disorders. In this presentation we review the non-pharmacologic factors that influence antidepressant response, and describe specific interventions that will improve outcomes for your patients on these medications

T101445 10:00–10:30

THURSDAY • JEUDI

T101050 How Non-Pharmacologic Factors Influence the Effectiveness of Antidepressants: Improving 10:30–11:00 outcomes

Where Evidence and Expectations Meet: The art and science of using Patient Decision Aids Jamie Falk, PharmD, Winnipeg, MB; Clayton Dyck, MD, CCFP, FCFP, Winnipeg, MB 802AB MTCC

Learning Objectives: 1. identify what Patient Decision Aids (PDAs) are (and are not) and how they can improve outcomes in comprehensive patientcentred care 2. efficiently access a large variety of reliable PDAs for common chronic conditions 3. utilize PDAs more efficiently and effectively to further incorporate and translate relevant evidence into their busy clinical practice Description: While patient-centredness is valued as an essential component of health care provision in family medicine, numerous studies demonstrate a disparity between the preferences of patients and the judgments of physicians when making treatment decisions.

Further adding to the complexity, patients are frequently challenged by multiple treatment options, and often end up uncertain of the trade-off between benefits and harms. In this interactive session, we will discuss how Patient Decision Aids (PDAs) can be used to assist clinicians and patients reach evidence-informed treatment decisions for a variety of common conditions, in keeping with patients‘ values and preferences. We will also discuss facilitators and barriers to the use of PDAs in a busy clinical practice, focusing on how to access them efficiently, assess their reliability, and consistently incorporate them into treatment decisions.

T101114 10:00–11:00

Tools for Practice: Using the online CAMH/Portico Primary Care Addiction Toolkit to optimize your clinical practice

Lisa Lefebvre, MDCM, MPH, CCFP, DABAM, Toronto, ON; Meldon Kahan, CCFP, FCFP, Toronto, ON; Kingsley Watts, MD, CCFP, FCFP, Toronto, ON 715A MTCC — Small group interactive workshop – limited seating.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. explain how Addiction Toolkit can screen, assess, and treat patients with alcohol, tobacco, or opioid problems 2. apply the Toolkit to several case studies to increase skill in treating patients with substance use disorders 3. discuss what additional tools may be useful to include in the Toolkit for primary care professionals Description: The recently reviewed and revised Primary Care Addiction Toolkit, edited by Drs Meldon Kahan and Kingsley Watts, provides evidence-based point-of-care tools, information, and patient resources for health care providers regarding alcohol, opioid, and tobacco use issues. Using case studies and personal devices, this interactive workshop will allow participants to learn how to use the Addiction Toolkit as a point-ofcare tool in their practice. Participants will require their own or a shared personal device such as a smart phone, tablet, or laptop computer to participate. Presenters will provide an overview of the Addiction Toolkit through a live demonstration of the website content and will guide participants as they work in small groups on clinical case studies, using the Toolkit. Finally, participants will be engaged in a discussion regarding the expansion of the Toolkit to suit their clinical needs, including the possibility of developing an online Community of Practice.

T101237 10:00–11:00

Simplified Approach to Red Eye: Evidence, pearls, and medico-legal pitfalls Approche simplifiée pour les yeux rouges : données, perles et pièges médico-légaux

Simon Moore, MD, CCFP, Mono, ON 718AB MTCC

Learning Objectives: 1. confidently differentiate various red-eye diagnoses, avoiding common medico-legal pitfalls 2. safely prescribe therapeutics for red eye, including antibiotics, according to recent evidence 3. quickly identify simplified Red-Eye Red Flags requiring urgent referral Description: Through use of the visually engaging and innovative Prezi presentation software (rather than PowerPoint), this lecture will help the learner confidently differentiate which red-eye patients need urgent referral vs those that can be safely discharged home. The talk also emphasizes three pearls that every family physician should know about red eye. The focus of this lecture is not only the scientific content, but also helping the learner apply clinical, patient-is-in-front-of-you management. Learners will discover the basics of relevant ophthalmic anatomy, a stepwise approach to managing a red eye, and practical evidence that can be applied immediately in a clinical context. This presentation is the updated version of a 2014 FMF presentation, which was evaluated with an average rating of 3.8/4 in all five categories. It incorporates updated recommendations and feedback from the 2014 presentations. Dr Simon Moore has consistently received outstanding teaching evaluations at past conferences, and has presented at the Family Medicine Forum in 2011–2014 on ”Basics of Starting Insulin in Type 2 Diabetes WITHOUT Losing Sleep at Night.”

Objectifs d‘apprentissage : 1. différencier sans tracas les divers diagnostics relatifs aux yeux rouges, tout en évitant les pièges médico-légaux courants 2. prescrire en toute sécurité un traitement pour les yeux rouges, y compris les antibiotiques, en fonction des données probantes récentes 3. identifier rapidement les signaux d‘alerte simplifiés, relativement aux yeux rouges, qui nécessitent une recommandation d‘urgence Description : À l‘aide du logiciel de présentation innovateur et visuellement attrayant Prezi, au lieu de PowerPoint, cette présentation aidera l‘apprenant à différencier sans tracas les patients aux yeux rouges nécessitant une recommandation d‘urgence de ceux qui peuvent recevoir leur congé en toute sécurité. La présentation souligne également trois perles que tout médecin de famille doit connaître au sujet des yeux rouges. En plus de s‘attarder au contenu scientifique, cette présentation aide l‘apprenant à appliquer la prise en charge clinique du patient « en face de lui ». Les apprenants découvriront les fondements de l‘anatomie ophtalmique pertinente, une approche par paliers de prise en charge des yeux rouges et des données pratiques pouvant être appliquées immédiatement en contexte clinique. Cette présentation est une mise à jour de la présentation du FMF 2014, laquelle a été évaluée à 3,8/4 en moyenne dans les cinq catégories. Elle incorpore une mise à jour des recommandations et commentaires reçus en 2014. Lors des conférences antérieures, Dr Simon Moore a constamment reçu des évaluations exceptionnelles au sujet de son enseignement; il a également présenté la séance Basics of Starting Insulin in Type 2 Diabetes WITHOUT Losing Sleep at Night lors des éditions 2011 à 2014 du Forum en médecine familiale.

T101628 10:00–11:00

The Unbearable Lightness of Being Mortal: Improving our skills with advance care planning Chris Frank, MD, CCFP, FCFP, Kingston, ON; Mireille Lecours, MD, CCFP, Stratford, PE 801AB MTCC

Learning Objectives: 1. discuss goals of care with people during office visits, during admission to hospital, and in long-term care facilities 2. describe the ethical and legal principles that guide ACP and goals of care communication 3. use one of several frameworks to guide their own communication strategies and styles

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Description: Although there is greater awareness of the importance of Advance Care Planning (ACP), patients often receive care that does not align with their goals of care. Family physicians play an important role in ACP and in discussing goals of care with patients in the office, hospital, and long-term care facilities. However, these discussions still cause discomfort and distress for physicians and patients alike. This session will provide approaches to guide difficult discussions in different clinical settings. We will use role play, videos, and audience expertise to improve participants‘ skills and comfort. Goals-of-care discussions are hard enough with a clearly terminal diagnosis such as cancer; this session will also consider communication skills needed to discuss goals of care with a frail older patient. We expect strong audience participation and would welcome discussion of challenging situations experienced by participants. At the end of the session, participants will feel prepared to introduce the topic of advance care planning in the office, hospital, or nursing home, and will have a variety of strategies to improve the patient‘s experience.

T102797 10:00–11:00

Calling a Spade a Spade: Barriers to identifying poor performance clearly on assessment Alison Eyre, MD, CCFP, FCFP, MD, CCFP, FCFP, Ottawa, ON; Carol Geller, MD, CCFP, FCFP, Ottawa, ON; Gary Viner, MD, CCFP, FCFP, Ottawa, ON; Eric Wooltorton, MD, CCFP, FCFP, Ottawa, ON 709 MTCC

Description: So we have done it! We have the fancy competency-based curriculum and the new tools to assess our learners, but what holds us back from identifying the the learner who is bellow competency? Why do some preceptors still avoid making the hard calls? While our focus on competency has made benchmarking easier, there still remain barriers to the honest assessment of the learners who are not meeting competency. It is critical to identify them in a competency-based curriculum early and to put supports in place. In this interactive workshop, we will look at the barriers identifying poor performance on in-training evaluation reports and daily assessment tools and share approaches for use at the preceptor and program levels. Participants will gain tools and strategies for honestly sharing their identifications with learners in difficulty and for providing these learners with support.

THURSDAY • JEUDI

Learning Objectives: 1. identify the barriers to preceptors clearly identifying poor performance on in-training evaluation reports and daily assessment tools 2. list at least two approaches to helping evaluators identify poor performance 3. identify approaches to help preceptors support the learner who is below competency, while making honest assessments

T102046 Common Musculoskeletal Injuries in the Child/Adolescent Athlete 10:00–11:00 Lisa Fischer, BScPT, MD, CCFP, DipSportMed, London, ON; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON; Roxanne MacKnight, MD, CCFP, FCFP, Miramichi, NB HALL G MTCC Learning Objectives: 1. define the musculoskeletal differences between a child/adolescent athlete and an adult athlete 2. identify the signs and symptoms of common musculoskeletal injuries in the child/adolescent athlete 3. create a management plan for common musculoskeletal injuries in the child/adolescent athlete Description: By the end of this session, the learner will be able to define the musculoskeletal differences between the child/adolescent athlete and the adult athlete, give examples of common injuries in child and adolescent athletes, and be able to formulate an effective management plan for these injuries.

T102423 10:00–11:00

Interactive ECG Workshop: Rate and rhythm Constance LeBlanc, MD, CCFP (EM), FCFP, MAEd, Halifax, NS; Janet MacIntyre, MD, FRCPC, Halifax, NS 716B MTCC

Learning Objectives: 1. effectively interpret common rate and rhythm disturbances 2. use clinical data to augment interpretation and therapy for rate and rhythm disturbances 3. recognize key rate and rhythm disturbances requiring emergency management Description: This interactive workshop on electrocardiogram (ECG) rate and rhythm will cover the breadth of rate and rhythm disturbances commonly encountered in emergency medicine, and include tips to help distinguish between rhythms and approaches to undifferentiated rhythms. Two speakers will review the essentials of rate and rhythm interpretation on the ECG. This interactive workshop will cover basic office-based ECG interpretation, clinical correlation, and initial management for common rate and rhythm disturbances. This is a case-based session using red laser pointers (provided) for many participants and green laser pointers for each presenter, allowing participation and interaction throughout the session. This session will include clinical scenarios, ECG interpretation, and management tips for physicians working in all types of emergency care settings. Pearls for care will complete the session.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T102739 10:00–11:00

Teaching a Man to Fish: Finding the right app Wes Jackson, MD, CCFP, FCFP, Airdrie, AB 501 MTCC

Learning Objectives: 1. choose useful, safe, evidence-based apps for mobile devices 2. find quality websites dedicated to medical app reviews 3. use three or more different methods to locate quality medical apps Description: “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.”—Maimonides In 2015, mobile devices have proven their utility in the practice of medicine, leading to the development of hundreds of thousands of medical apps, created for physicians and their patients, with new ones appearing daily. Some apps, like fish, are indispensable, while the utility of others depends on the user; still others are potentially dangerous. How does a busy physician efficiently find useful, safe, and evidence-based apps in this environment? This workshop will ”teach a man to fish” through the discussion of not only ”fish” (apps), but also ”fishing holes” (eg, websites), and ”tackle” (eg, aggregating tools) useful for finding just the right app. The presenter has been interested in mobile devices in medicine for the last 20 years and would like to be an avid fisherman—once he finds the time.

T102555 Improving Coordination of Care Between Family Physicians and Cancer Care 10:00–11:00 Eva Grunfeld, MD, DPhil, CCFP, FCFP, Toronto, ON; Patti Groome, PhD, Kingston, ON; Bo Miedema, MA, PhD, Halifax, NS; June Carroll, MD, CCFP, FCFP, Toronto, ON; Melissa Brouwers, MA, PhD, Hamilton, ON 401 MTCC Learning Objectives: 1. recognize the factors associated with coordination of cancer care (from diagnosis to survivorship) and how they vary across Canada 2. describe models of care to improve coordination between family physicians and cancer care and how those vary across Canada 3. relate family physicians‘ experiences and needs related to cancer risk assessment and other aspects of personalized cancer medicine Description: Family physicians (FPs) are the first and most frequent point of contact for cancer patients within the health care system during most phases of cancer care. Coordination of care between FPs and cancer specialists is vital to improve the quality and outcomes of care and yet is known to be problematic. Patients often need to consult many health professionals across multiple health care settings, which often leads to fragmented and uncoordinated care. The introduction of models of care and tools to improve coordination of care is essential to optimize the role of FPs along the breadth of the cancer care continuum, including cancer risk assessment. The Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) is a pan-Canadian multidisciplinary team of FPs, cancer specialists, and researchers who have undertaken a comprehensive analysis of coordination of cancer care (from diagnosis to survivorship) across Canada. At this workshop, we will present the findings of CanIMPACT related to the coordination and quality of cancer care and how that varies across Canada, based on 1) patient care during cancer diagnosis, chemotherapy treatment, and follow-up/survivorship using administrative health databases; 2) patient and provider experiences and perspectives derived from focus groups and individual interviews; 3) models of care, tools, and strategies to improve coordination of care that have been introduced across Canada or in other countries; and 4) FPs‘ experiences, desired roles, and needs regarding education and practice tools related to personalized cancer risk assessment and other aspects of personalized cancer medicine. We will present a model of care that has been developed, based on these findings, to improve the coordination of cancer care. Workshop participants will have an opportunity to provide feedback on the proposed model of care, which will then be revised for later testing in a randomized clinical trial.

T107236 10:00–11:00

Safeguarding Caring and Compassion in an Era of Competence-Based Education Elaine Van Melle, PhD, Kingston, ON; B.D. Hodges, MEd, PhD, MD, FRCPC, Toronto, ON 711 MTCC

Learning Objectives: 1. describe the tension between the concepts of ”caring” and ”competence” 2. develop a personal stance on the need to develop ”a call to caring” 3. consider the role of professional self-identity in integrating caring and competence Description: Competence-based education models are increasingly popular in medical education. The premise is to define more clearly discrete, observable competencies and to monitor the trajectory of learners using concepts such as milestones. This is relatively straightforward for competencies that are knowledge- or skills-based but more challenging for complex domains such as professional self-identity formation and the ability to demonstrate caring. Further, much of the drive toward competence-based models arises from a desire to shorten training and render it more efficient. These imperatives might run counter to ensuring the development of qualities such as compassion. This interactive workshop, based on the work of both the Royal College of Physicians and Surgeons of Canada‘s 2015 CanMEDS revisions and the Associated Medical Services (AMS) Phoenix Project, explores these challenges and focuses on ways to safeguard caring and compassion in an era of competence-based education.

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T108248 10:00–11:00

What‘s New? The top 10 research studies that will impact clinical practice for family physicians / uoi de neuf? Les dix meilleures études de recherche qui changeront la pratique clinique pour les Q médecins de famille

David Kaplan, MD, CCFP, Toronto, ON; June Carroll, MD, CCFP, FCFP, Toronto, ON; David White, MD, CCFP, FCFP, Toronto, ON; Moderator / Modératrice : Wendy Norman, MD, CCFP, FCFP, Vancouver, BC HALL F MTCC Learning Objectives: 1. synthesize clinically relevant research presented at the primary care annual research meeting (NAPCRG) 2. stimulate the interest of practising family physicians in primary care research

Objectifs d‘apprentissage : 1. synthétiser des recherches cliniquement pertinentes qui ont été présentées lors de la conférence annuelle du NAPCRG 2. stimuler l‘intérêt des médecins de famille praticiens en matière de recherche en soins primaires Description : Dans un rappel des présentations qui ont fait un tabac au cours des deux dernières années, trois conférenciers hors pair présenteront dix études des plus pertinentes sur le plan clinique pour les médecins de famille, choisies parmi plus de 500 études présentées lors de la conférence du North American Primary Care Research Group (NAPCRG). Ces trois chercheurs en médecine familiale parleront des présentations qu‘ils ont trouvé les plus pertinentes pour leur propre pratique et de ce qu‘ils croient que tout médecin de famille devrait savoir. Les conférenciers présenteront trois ou quatre études, souligneront ce qui est nouveau, pourquoi ces études sont importantes et comment elles changeront la pratique. L‘accent sera mis sur les problèmes qui sont communs et importants dans le contexte de la médecine familiale. Des exemplaires des résumés et des présentations originaux seront disponibles. La conférence du NAPCRG est le plus important forum international de diffusion de nouvelles connaissances en soins primaires; cette séance fera état des meilleures présentations effectuées au cours de la conférence du NAPCRG pour un public clinique. Cette séance pourra intéresser les chercheurs en médecine familiale

T108667 10:00–11:00

THURSDAY • JEUDI

Description: In a repeat of hugely successful presentations from the past two years, three outstanding speakers will present the top 10 studies clinically relevant to family physicians from among over 500 presented at the North American Primary Care Research Group (NAPCRG) conference. Three family physician researchers will discuss what presentations they found most meaningful for their own practice and what they think every practising family physician should know. Each speaker will outline three or four studies, emphasizing what is new, why it is important, and how it can change practice. The focus will be on problems that are common and important in the family medicine setting. Copies of the original abstracts and presentations will be available. NAPCRG is the premier international forum for communicating new knowledge in primary care; this presentation will showcase the best of NAPCRG for a clinical audience. This session might be of interest to family medicine researchers. .

Mainpro+ … A New Look, With New Ways to Learn (1) Mainpro+ … Un nouveau look; de nouvelles façons d‘apprendre (1)

Eric Wong, MD, CCFP – Regional Educator, Ontario Region / Éducateur régional, région de l‘Ontario, London, ON; Scott MacDonald, MD, CCFP (EM), FCFP – Regional Educator, Atlantic Region / Éducateur régional, région de l‘Atlantique, Bedford, NS 803A MTCC Join us for an informative session on Mainpro+ and the new, practice-centred ways to earn CPD credits for activities you do on a daily basis. Also, hear the latest updates on fellowship, accreditation, and CACs. The CFPC is committed to providing quality CPD to meet your changing interests and learning needs. Participants may claim an additional Mainpro-M1 credit for this session.

Soyez des nôtres pour une séance d‘information sur Mainpro+ et sur les nouvelles façons d‘obtenir des crédits de DPC pour des activités que vous effectuez au quotidien. De plus, vous pourrez vous renseigner sur les nouveautés concernant le titre de Fellow, l‘agrément et les CCA. Le CMFC s‘est engagé à fournir des programmes de DPC de qualité qui conviennent aux intérêts de ses membres et répondent à leurs besoins en matière d‘apprentissage. Les participants peuvent réclamer un crédit Mainpro-M1 additionnel pour cette séance.

T115050 “You Want Me to Teach?” Get ready with the new CFPC Fundamental Teaching Activities Framework 10:00–12:15 Viola Antao, MD, CCFP, MHSc, FCFP, Toronto, ON; Marion Dove, MD, CCFP, Montreal, QC; Allyn Walsh, MD, CCFP, FCFP, Hamilton, ON; Stewart Cameron, MD, CCFP, FCFP, MAEd, Halifax, NS; Sudha Koppula, MD, CCFP, Edmonton, AB; Teresa Cavett, MD, CCFP, FCFP, Winnipeg, MB 703 MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. describe and apply concepts of fundamental teaching activities (FTAs) 2. use the FTA Framework to develop a personal learning plan for professional development 3. Identify tools and resources for implementation of this plan Description: This session will begin with a brief interactive presentation providing the background concepts and the supporting literature behind the development of the Fundamental Teaching Activities (FTA) Framework. Working in small groups, participants will use the framework to develop their personal learning plan. In a group, participants will share the results of their planning activities, and discuss how this framework could be useful for their professional development.

T119659 Understanding and Using the Triple C Evaluation Survey Data Within Your Own Program: 10:00–12:15 Opportunities for program evaluation

Shelley Ross, PhD, Edmonton, AB; Douglas Archibald, PhD, Ottawa, ON 705 MTCC

Learning Objectives: 1. describe the Family Medicine Longitudinal Survey and the methodology used for implementation 2. consider ways to interpret the sample data emerging for the purposes of improving curricula design or conducting further research 3. discuss opportunities and challenges related to the use of the Family Medicine Longitudinal Survey as part of Triple C‘s program evaluation and define ways to address areas where further data are needed Description: As part of the Triple C Evaluation Plan, the Triple C Working Group for Survey Development is continuing to collect data from residents about multiple aspects related to the Triple C. Surveys are administered at start of residency program (T1), at time of graduation from residenc— Small group interactive workshop – limited seating.y (T2), and early in practice (within the first five years of practice; T3). All data are anonymous, but coding allows researchers to link T1, T2, and T3 data. In this interactive workshop, we will first introduce and describe the methodologies used and offer examples of the dataset, including an overview and interpretation of results to date. Time will be dedicated to explaining how to interpret the data, with examples from some ongoing projects. In the second half of the workshop, participants will work in small groups to test ways to interpret and use the data for their own contexts. Opportunities to consider enhancing curricula design or developing research questions will be explored.

T101227 10:30–11:00

Caring for Patients by Video Telemedicine: How does this fit into family practice?

Ellen Wiebe, MD, FCFP, Vancouver, BC; Rosanna Lima, MD, CCFP, Pitt Meadows, BC 716A MTCC

Learning Objectives: 1. describe which patients and which situations are best suited to video telemedicine visits 2. troubleshoot scheduling, billing, and technical issues with video telemedicine 3. address privacy concerns and informed consent Description: In the past, telemedicine was used successfully for remote communities, but now it can be part of a city doctor‘s practice, too. We will present our findings from a qualitative study in which we interviewed family doctors and their patients about how they used video telemedicine for ordinary office visits. Telemedicine visits can benefit patients who have difficulty coming into the office, for example, patients caring for young children or elders and those with disabilities. We will discuss using free video platforms, such as Skype and FaceTime, as well as medical video platforms. We will show how a busy family practice can mesh video telemedicine visits smoothly and efficiently into the daily schedule and how well communication between doctor and patient occurs via video. Video visits can take the place of some of the old-fashioned house calls where family doctors saw their patients in context and learned more about them (but without the cup of tea and piece of homemade cake!).

T94713 10:30–12:15

Fire Over Ice: In the face of recalcitrant non-genital warts Lawrence Leung, MD, MA, MBBChir, MFM(Clin), DipPractDerm, CCFP, MRCGP, FRACGP, FRCGP, Kingston, ON 501 MTCC

Learning Objectives: 1. recall the pathology, prevalence, and behaviour of recalcitrant non-genital warts 2. identify the mechanisms of actions, benefits, and cautions of using hyfrecation for treating non-genital warts 3. apply the knowledge and skills of hyfrecation in treating non-genital warts in daily practice Description: Verruca vulgaris (non-genital common wart) is a common skin condition in general practice that often resolves without treatment. For lesions needing treatment, our first-line treatment in family practice includes topical salicylic acid and liquid nitrogen application. In clinical practice, almost half of these lesions often persist despite repeated treatment and become recalcitrant warts, which then pose a challenge to treatment for the family physician. Hyfrecation is a form of electrosurgery that was described more than a century ago and has been used sporadically for skin lesions, including recalcitrant warts. The author would like to illustrate a step-by-step approach, with aid of photos and videos, to elucidate the benefits of hyfrecation for recalcitrant non-genital warts, aiming to support its value as an effective treatment modality for the busy family physician.

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T94714 Coaching Competencies for Physicians 11:15–12:15 Nancy Merrow, MD, CCFP, CFPF, Queensville, ON; Cecile Andreas, MD, CCFP, CEC, Cranbrook, BC; James Read, MD, CCFP(EM), CEC, Warkworth, ON 717B MTCC Learning Objectives: 1. structure a patient encounter to change a complaint into a goal 2. use artful questions to stimulate insight and move patients from goal to action 3. create a cycle of accountability that promotes patient ownership of their problems

T99453 11:15–12:15

Dangerous Ideas Soapbox – TribuneIdées aux idées dangereuses Wendy Norman, MD, CCFP, FCFP, DTM&H, MHSc, Vancouver, BC 714AB MTCC

Learning Objectives: 1. acquire new perspectives on the scope and approach to primary care practice, innovation, and research 2. understand new leading-edge or unusual issues in family practice 3. engage in discussion and idea generation with national and international colleagues

THURSDAY • JEUDI

Description: Coaching is gradually entering mainstream health care as an adjunct to traditional advice giving and problem solving between practitioners and patients. In the move to a more patient- focused health system, coaching competencies add to the clinician‘s tool kit in managing competent patients with complex chronic conditions and lifestyle-related health issues. The change of mindset for physicians to be effective coaches for their patients requires new knowledge and practice of specific techniques. A coach holds the person being coached as fully capable in their own life, and holds the person accountable for their stated goals and action plans. The coach is non-judgmental about why the person does what they do, and remains curious about what the person wants to achieve. This workshop is designed to introduce physicians to what coaching is in the health care setting, to describe how coaching is emerging in the health literature, and to engage participants in exercises that can be immediately applied as new competencies in the clinical setting.

Description: The Dangerous Ideas Soapbox – Tribunes aux idées dangereuses is the wildly popular session offered at FMF since 2013. This session offers a platform for FMF innovators to share important ideas It is a rigorous competition.The finalists participate in lightning presentations. The audience uses electronic voting to select the winner and the presentations are published in CFP.

T99899 11:15–12:15

Mood Disorders in Pregnancy and Postpartum William Watson, MD, CFPC, FCFP, Toronto, ON; Simone Vigod, MD, MSC, FRCPC, Toronto, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. identify updated risk factors for mood disorders in pregnancy and postpartum 2. describe techniques and new screening tools for diagnosing mood disorders in pregnancy and postpartum 3. explain newer approaches to treatment including psychotherapy and drug treatment Description: Mood disorders in pregnancy and postpartum are common (prevalence of 10–20%) and have an important impact on mothers, their children, and the entire family. They affect the quality of the mother‘s relationship with her child and the child‘s cognitive and social development. In addition, these mothers often face a lifetime of increased risk for recurrence of their illness. Unfortunately, mood disorders are under-treated during pregnancy and after childbirth. Family physicians are uniquely positioned in the health care system to help mothers and their families with perinatal mood disorders. Knowledge of risk factors, diagnostic tools, and up-to-date treatment recommendations can help family physicians manage mood disorders in a timely and effective manner. Using interactive case scenarios, this workshop will emphasize the prevention, diagnosis, screening, treatment, and therapeutic techniques that can assist family physicians in managing mood disorders in pregnancy and the postpartum period.

This is a small group interactive workshop. Seating is limited. The session will be closed when the seating reaches maximum capacity.

T100363 11:15–12:15

If Sex Sells, I‘m Buying: Men‘s sexual health update 2015 Ted Jablonski, MD, CCFP, FCFP, Calgary, AB 701AB MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. define normal male sexual function 2. review the diagnoses and treatments of major male sexual dysfunctions 3. debate the ”hot button” issues of men‘s sexual health in 2015 Description: While most practitioners would agree that the sexual health of their male patients is important, many find this area of medicine challenging.

Even the understanding and communication of what is “normal” can be fraught with myths and misconceptions. This session hopes to provide an updated review of male sexual dysfunctions and their current treatment options. As there are always controversies, a review of some of the most contentious issues of 2015 will be presented and debated. Dr Ted Jablonski is a family physician based in Calgary, Alberta, where he is currently in full-time practice within an innovative, inter-disciplinary community family practice. In addition to family medicine, Jablonski does consultancy work in men‘s health (with urologist Dr Jay Lee), and sexual and transgender medicine for Southern Alberta and central British Columbia at the Jablonski Sexual Health Clinic in Calgary. Ted has a special interest in CHE for physicians, medical professionals, and the public, and has been involved in the creation and delivery of a wide range of programs at provincial, national, and international levels.

Ted is a sought-after speaker, trainer, media spokesperson, and educator with many conference, radio, television, and video credits.

T101345 Pan-Canadian Models of Care for Pregnant Substance-Using Women: Primary care-based approach 11:15–12:15 Eric Cattoni, MD, CCFP, Edmonton, AB; Ron Abrahams, MD, CCFP; Suzanne D. Turner, MD, MBS, CCFP, ABAM, Toronto, ON; Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Alice Ordean, MD, CCFP, MHSc, FCFP, Toronto, ON; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe various approaches for care of pregnant women with substance use disorders 2. explain trends in perinatal addiction relevant to clinical practice 3. utilize novel strategies for the care of women encountered in practice Description: Substance use disorders in pregnancy are common in urban and rural settings across Canada. Due to medical and social complexity, the care of these women largely rests with family physicians. This workshop will identify approaches of Canadian family physicians reflecting unique regional needs. Topics will include ambulatory integrated care for addiction in pregnancy, inner city perinatal addiction and trauma-informed care, special considerations for rural substance-addicted mothers, development of programs for care in poorly resourced regions, and new trends in substance use treatment and pregnancy. This session will include didactic and interactive components to encourage discussion.

Participants will gain an enhanced understanding of perinatal addictions across Canada, and strategies from front-line providers to apply in their communities.

T101508 11:15–12:15

Unlocking the Secrets: How we approached the development of a Web-based resident assessment system

Eric Wong, MD, CCFP, MClSc(FM), London, ON; Fred Ross, MD, CCFP, Winnipeg, MB; Charles Mehagan 709 MTCC

Learning Objectives: 1. describe key considerations for the development of a Web-based resident assessment system 2. Describe key insights from the authors‘ experience with the design and implementation of a Web-based resident assessment system Description: The family medicine residency program at the Schulich School of Medicine & Dentistry embarked on the development of a Web-based resident assessment system in response to new CFPC accreditation standards published in 2013. The assessment system was first rolled out in July 2014 and is under continuous improvement and development. The purpose of this workshop is to share lessons learned and insights from the design and implementation of the resident assessment system. The presenters (a faculty member, a program manager, and a Web developer/programmer) will start with an introduction to the resident assessment system, then discuss the principles used in design and implementation and the insights gained from the design and implementation process. The majority of the session will be a Question & Answer session to assist in the design and development of similar assessment systems at the participants‘ programs.

T101606 It‘s Overgrown Toeskin NOT Ingrown Toenail!

11:15–12:15 Henry Chapeskie, BSc, MD, CCFP, FCFP, CAME, Thorndale, ON

716A MTCC

Learning Objectives: 1. recognize the cause of ”ingrown toenails” 2. perform minor surgical procedure for ”ingrown toenail” Description: ”Ingrowing” toenails are a common and painful problem. This is an innovative approach to an old problem. The term ”ingrown toenail” incriminates the nail as the causative factor; however, there is excellent evidence-based research demonstrating that there is no nail abnormality and that the problem is due to an excessive amount of soft tissue. Removal of the excessive soft tissue results in less bulging over the nail with weight bearing. The nail is not touched! Physicians will stop removing toenails. Patients with ”ingrown toenails” can expect to have an excellent cosmetic result. The technique is technically simple and can easily be performed in the physician‘s office.

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T101676 Screening for Chronic Disease: A review and update on screening for depression, diabetes, 11:15–12:15 hypertension, and obesity

Lisa Freeman, MD, CCFP, Edmonton, AB HALL G MTCC

Learning Objectives: 1. review new non-cancer screening guidelines for 2015, including those from the Canadian Task Force on Preventive Health Care 2. evaluate recent non-cancer screening guidelines to weigh the benefits and risks of screening for patients 3. integrate screening and other preventive health and health promotion interventions into their busy practice

T101785 11:15–12:15

A New Algorithm for the Diagnosis of Hypertension: CHEP 2015 recommendations Mark Gelfer, MD, CCFP, FCFP, Vancouver, BC 715B MTCC

Learning Objectives: 1. understand the new algorithm for diagnosis of hypertension 2. explain why electronic BP measurement is preferred over auscultation; perform and interpret ambulatory blood pressure measurement (ABPM) 3. describe the importance of identifying patients with white-coat hypertension

THURSDAY • JEUDI

Description: More and more Canadians are affected by chronic, non-cancer diseases like obesity, hypertension, diabetes, and depression.

Family physicians strive not only to provide exemplary treatment to patients with these diseases, but also to prevent and screen for such conditions. This session will cover new 2015 guidelines for non-cancer screening, review recent guidelines, and provide practical strategies to integrate screening and other preventive health and health promotion interventions into a busy family practice.

Participants will become comfortable with the Canadian Task Force on Preventive Health Care 2015 guideline for obesity in adults, as well as numerous other screening guidelines for common chronic conditions, including hypertension, diabetes and depression.

Skills to evaluate screening recommendations in the context will be covered; participants will become comfortable evaluating and communicating the risks and benefits of screening with their patients. Practical methods to integrate screening and other preventive health and health promotion strategies will be learned, including how to effectively work with staff and technology to optimise screening and preventive care. This session is intended for practicing family physicians but will be suitable for medical students, residents and allied health providers who wish to master best practices in non-cancer screening.

Description: The Canadian Hypertension Education Program (CHEP) has reviewed the published literature and determined two important gaps in current practice: 1. Auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. 2. Recent data indicate that patients with white-coat hypertension (WCH) must be identified earlier in the process and in a systematic manner rather than on an ad-hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications.

T102055 Management of Persistent Post-Concussive Symptoms 11:15–12:15 Prise en charge des symptômes persistants post-commotion cérébrale

Lisa Fischer, BScPT, MD, CCFP, DipSportMed, London, ON HALL F MTCC

Learning Objectives: 1. define ”sport concussion” and ”post-concussive symptoms” 2. create a management plan for a patient with post-concussive symptoms 3. identify up-to-date resources to assist with management of post-concussive symptoms Description: Concussions continue to increase in number and it is often the responsibility of the family physician to manage patients with persistent sport concussive symptoms. By the end of this session, participants will be able to identify resources and create a management strategy for patients with post-concussive symptoms, including advice on their return to activity/sport.

Objectifs d‘apprentissage : 1. définir la « commotion cérébrale dans le sport » et les « symptômes post-commotion cérébrale » 2. concevoir un plan de prise en charge pour un patient qui présente des symptômes post-commotion cérébrale 3. choisir des ressources à jour pour aider à prendre en charge les symptômes post-commotion cérébrale Description : Le nombre de commotions cérébrales continue de grimper et il revient souvent au médecin de famille de prendre en charge les

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE patients qui présentent des symptômes persistants post-commotion cérébrale liée au sport. À la fin de la séance, les participants pourront choisir les ressources et concevoir une stratégie de prise en charge pour les patients qui présentent des symptômes post-commotion cérébrale, y compris des conseils sur la façon de reprendre leur activité ou leur sport.

T102064 Pearls in Thrombosis for Family Physicians: A case-based approach 11:15–12:15 Alan Bell, MD, CCFP, Thornhill, ON; Benjamin Bell, MD, FRCPC, Toronto, ON 717A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. manage patients presenting with diseases requiring consideration of anticoagulation Description: Topics to be covered include appropriate dosing of anticoagulants in atrial fibrillation; diagnosis and management of venous thromboembolic disorders (VTE), including deep venous thrombosis and pulmonary embolism; duration of therapy in VTE for secondary prevention; and perioperative management of anticoagulants. Current guidelines, including those of the Canadian Cardiovascular Society and the American College of Chest Physicians, are the standard upon which the session is based. Participants will be provided with point-of-care clinical tools, developed and peer reviewed by Thrombosis Canada, with which to apply the principles of this presentation to their practice.

T101078 11:15–12:15

First Five Years in Family Practice: Using social media and online technology safely in your practice Scott MacLean, MD, CCFP, Edmonton, AB 716B MTCC

Learning Objectives: 1. identify medico-legal issues surrounding the use of social media and online tools in patient care 2. recognize effective methods of using social media tools safely in patient care and practice 3. employ guide to using social media and online technology in early practice Description: The First Five Years in Family Practice Committee will review the use of social media and online technology in family medicine, including a review of how these tools are used internationally, and the medico-legal concerns in Canada surrounding these methods. Several effective methods of using social media and online tools in primary care will be demonstrated; and a one-page guide to using social media effectively will be provided to participants during the session.

T102171 Suffering and Finding Meaning 11:15–12:15 Peter Selby, MBBS, CCFP, FCFP, Dip ABAM, FASAM, Toronto, ON; Ellen Anderson, MD, MHSc, Sooke, BC; Dori Seccareccia, MD, CCFP (EM), MClSc, Toronto, ON; Chris Frank, MD, CCFP, FCFP, Kingston, ON 711 MTCC Learning Objectives: 1. relate and discuss how the experience of witnessing patient and family suffering affects one‘s level of compassion and acceptance 2. co-create a practical framework to support patients to find meaning in their suffering 3. co-create a practical framework to support one‘s self and colleagues in maintaining balance in coping with distress, suffering, and difficulty in practice Description: Human suffering takes many forms and occurs throughout the lifespan. Physical, emotional, spiritual, and existential suffering are an integral part of human existence, and family physicians encounter it on a daily basis. Finding meaning in experience is a fundamental human desire. This facilitated small group session will use the art of story weaving (narrative and improvisation) to safely and gently explore some of the difficult and painful emotions family physicians might experience when caring for those who are suffering. We will also evoke the participant‘s experience and wisdom to discuss how we can support our patients to find meaning and resolution of suffering in their own distress. The session concludes with the co-creation of ways to be aware of these effects on ourselves and of how we can be renewed by finding meaning in our practice.

T102341 Ongoing Management of Depression in Adolescents and Young Adults 11:15–12:15 Jan Young, MD, CCFP, FCFP, Hamilton, ON; Debra Earl, BScN, RN, Hamilton, ON; Debbie Nifakis, PhD, Hamilton, ON; Catharine Munn, MSc, MD, FRCPC, Hamilton, ON 401 MTCC Learning Objectives: 1. describe the prevalence and functional impact of depression in adolescents and young adults and the current best practices for initial treatment and ongoing management 2. explain the value of using a simple motivational interviewing template to encourage self-management 3. employ strategies to integrate initiatives into one‘s own practice to screen for mental health problems and to monitor the severity of symptoms and progress of treatment Description: This interactive session will update providers on depression diagnosis and management in adolescents and young adults. We will describe a quality improvement initiative used in a collaborative shared-care team of family physicians, counselors, a mental health nurse, and a psychiatrist, employing the Patient Health Questionnaire-9 to screen for, and guide the management of, depression in the emerging adult fmf.cfpc.ca

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population (ages 18 to 25). There has been substantial media coverage of the increased demand for mental health services at Canadian postsecondary campuses, particularly over the last decade. In 2013/2014 the McMaster Student Wellness Centre engaged in a clinic-wide initiative to improve our ability to detect, monitor, treat, and track students with depressive symptoms using a plando-study-act model for promoting quality improvement. Also examined were the processes of intake triage; scheduling appointments; goal setting for self-care; referral to groups for education, skill-building, or therapy; and referral to other providers.

T102871 11:15–12:15

Practical Approach to Integrating Advance Care Planning Into Primary Care Nadia Incardona, MD, CCFP, MHSc, Toronto, ON 802AB MTCC

Learning Objectives: 1. describe an interprofessional approach to initiating advance care planning conversations in primary care through the use of conversation guides and e-learning modules 2. differentiate advance care planning from goals of care, plans of care, levels of care, and consent for treatment 3. integrate advance care planning for healthy adults, adults living with chronic illness, and adults in the last year of life

THURSDAY • JEUDI

Description: Advance care planning (ACP) incorporates value-based decision making into early discussions surrounding end-of-life care. There is growing recognition that ACP is a valuable process to improve end-of-life care by supporting patient autonomy, reducing unwanted medical interventions, and improving patient and family satisfaction. However, despite this recognition, many Canadians have not been engaged in advance care planning conversations. Improved health care provider education has been called for. In Ontario, the Ministry of Health has set up the Health Links initiative, with a mission to provide coordinated, efficient, and effective care to patients with complex needs. The East Toronto Health Link has been charged with developing an ACP framework. As part of the focus on health care provider, education, workshops, and e-learning modules have been developed. This session is intended for all health care providers who work in primary care. This workshop will provide a brief overview of how to initiate advance care planning conversations with patients at different stages of their health. Participants will be able to distinguish important differences between ACP, advance directives, goals of care, and treatment plans. Relevant legal issues relating to consent, capacity, and substituted decision making will be defined. The session will include role-modeling of ACP conversations and introduce participants to the conversation guides, workbooks, and e-learning modules developed by the East Toronto Health Link.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T95406 Red and Itchy: How to approach and manage common skin conditions and avoid pitfalls 13:45–14:15 Lawrence Leung, MA, MB BChir, MFM(Clin), DipPractDerm(Wales), MRCGP, FRACGP, FRCGP, CCFP, Kingston, ON 701AB MTCC Learning Objectives: 1. identify common skin conditions in family medicine including the ”big five” diagnoses 2. recognize evidence-based management in reference to treatment guidelines 3. acquire clinical pearls for effective management and avoidance of pitfalls Description: Skin conditions constitute up to 15% of all consultation issues presented to family physicians practising in Canada. However, dermatology is one of the least-taught subjects, in both the undergraduate medical curriculum and family medicine residency program.

As a result, family physicians often feel unsure of the correct diagnoses, let alone proper management, of skin problems commonly presented to their clinics. This either leads to (1) unnecessary referrals to dermatologists which often translate to long waiting times for the patients before receiving proper treatment, or (2) reflex-arc type prescriptions for steroids which can sometimes do more harm than good.

In this session, a systematic approach will be adopted for presenting the common skin conditions seen in family medicine, in particular the “big five” diagnoses. Emphasis will be placed on how to make the correct diagnoses with an update on guidelines for evidence-based management. Ample clinical pearls will also be shared with the audience, and additional cautionary notes for potential pitfalls.

T95413 Odd and Scary: How to approach and manage unusual skin conditions and avoid pitfalls 14:15–14:45 Lawrence Leung, MA, MBBChir, MFM(Clin), DipPractDerm(Wales), MRCGP, FRACGP, FRCGP, CCFP, Kingston, ON 701AB MTCC Learning Objectives: 1. recognize overview spectrum of unusual conditions of skin and its appendages seen in family medicine 2. adopt a systematic and effective approach for investigations, diagnosis, and management 3. gain clinical pearls for odd and scary skin conditions and avoid pitfalls Description: Skin conditions constitute up to 15% of all consultation issues presented to family physicians practising in Canada. However, dermatology is one of the least-taught subjects, both in the undergraduate medical curriculum and family medicine residency program.

As a result, family physicians often feel unsure of the correct diagnoses, let alone proper management, of skin problems presented to their clinics. Such scenarios are further worsened if the skin conditions look unusual or daunting. This leads either to 1) unnecessary referrals to dermatologists which often translate to long waiting times for the patients before receiving proper management, or 2) reflexarc decisions for skin biopsies which can sometimes do more harm than good. In this session, a systematic approach will be adopted for presenting the spectrum of unusual skin conditions that can be encountered in family medicine, in particular the “odd and scary” ones. Emphasis will be placed on how to arrive at the correct diagnoses and judicious use of investigations like skin biopsies and dermatoscopy. Relevant guidelines for evidence-based management will be given. Finally, ample clinical pearls will be shared with the audience, together with cautionary notes for potential pitfalls.

T96072 13:45–14:45

Trauma-Informed Care: Why it matters for you and your patients Eva Purkey, MD, CCFP, Kingston, ON; Tracey Beckett, Gerontology, BSW, MSW, RSW, Kingston, ON HALL G MTCC

Learning Objectives: 1. recognize the prevalence of adverse childhood experiences in the general population 2. identify patients in your practice with a history of adverse childhood experiences (trauma) using the ACE tool 3. anticipate how adverse childhood experiences might impact the future health of your patients and consider how to adjust your practice accordingly Description: A major issue in health care is the high incidence of trauma and adverse experiences in the lives of many patients. Despite extensive awareness and over one hundred years of documentation, this issue remains inadequately addressed by mainstream medicine. Recognizing the prevalence of trauma, adjusting risk based on adverse childhood experiences, and understanding how to approach patients with a history of trauma is essential in providing appropriate and effective care. While the field of mental health and addictions has increasingly recognized trauma-informed health care as a standard, this is not the case in general practice and primary care. The Adverse Childhood Experiences (ACE) study and the ACE score have been used to examine the relationship between childhood experiences and long-term physical, mental, and public health problems. Research from the ACE study shows increasingly that early childhood adverse experiences are risk factors not only for mental health and addiction but also for behavioural risk factors (smoking, obesity, etc.). They are also associated with so-called physical or non-psychiatric medical conditions, in addition to somatic syndromes including various chronic pain syndromes and IBS. Finally, there is increasing understanding of the biological link between adverse childhood experiences and risk of cardiovascular disease, respiratory disease, and cancer. These associations and increased rates persist irrespective of traditional risk factors. Given the high prevalence of trauma in society, there is a responsibility to bring awareness of trauma-informed techniques into the provision of excellent primary care.

The principles behind this type of care include a deep integration of the concepts of physical and emotional safety; trustworthiness and consistency; choice; collaboration with service users; and empowerment. These are arguably principles that should inform all primary care delivery, all the more so given the prevalence of trauma and the challenges in identifying all trauma survivors.

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T96386 13:45–14:45

Mood Disorders in Women During the Reproductive Years Christiane Kuntz, MD, CCFP, FCFP, NCMP, Ottawa, ON 501 MTCC

Learning Objectives: 1. increase awareness of impact of, manifestations of, diagnostic criteria for, and treatment options for mood disorders in reproductive-age women 2. identify specific mood disorders associated with or affected by hormonal fluctuation during the menstrual cycle, pregnancy, postpartum, and perimenopause 3. apply learning pearls through a review of cases

T100740 FASD 2015: Updated Guidelines and Toolkit 13:45–14:45 Murray Trusler, MD, CCFP, FCFP, Fairmont Hot Springs, BC; Ken Trusler, Invermere, BC; Pat Mousmanis, Lisa Graves, Liz Grier, Bill Watson, Courtney Green, Jocelyn Cook, Audrey MacFarlane, Tracey Milner, Nancy Pool 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. define the updated/revised guidelines for FASD 2. describe the role of family physicians in the prevention and diagnosis of FASD and ongoing support of persons living with FASD 3. use one of the toolkits described and cite one example of an FASD centre of excellence

THURSDAY • JEUDI

Description: This session will seek to improve the participants‘ awareness of the impact of, manifestations of, diagnostic criteria for, and treatment options for mood disorders in reproductive-age women. We will review factors that increase suicidal risk. Specific mood disorders associated with or affected by hormonal fluctuation during the menstrual cycle, pregnancy, postpartum, and perimenopause will be highlighted. PMS will be covered in detail, recognizing its impact on health and society. The etiology and pathophysiology of PMS will be discussed. Clinical assessment tools will be highlighted and treatment options for PMS will be explored. Learning pearls will be applied through a review of cases.

Description: Family physicians have an important role in prevention of Fetal Alcohol Spectrum Disorder (FASD) during the prenatal period, supporting families and patients during the diagnostic process and providing care to individuals living with FASD. Workshop participants will review the NEW 2015 updated diagnostic guidelines, approaches to prevention during the preconception and prenatal periods, and the role of family physicians in the ongoing care of persons living with FASD. Toolkits designed for use in the family medicine setting will be described. The Lakeland Centre for FASD will be showcased as a leader in developing unique ruralbased FASD services.

T101080 13:45–14:45

First Five Years in Family Practice: Improving efficiency and time management in your early career Scott MacLean, MD, CCFP, Edmonton, AB 716B MTCC

Learning Objectives: 1. relate the factors contributing to inefficiency and poor time management in family medicine 2. discuss strategies to improve efficiency, time management, and well-being in early career physicians 3. apply methods to improve physician well-being and work-life balance in early career Description: The First Five Years in Family Practice Committee has invited Dr John Crosby to discuss his experiences related to improving practice efficiency with a focus on early career physicians. Factors contributing to inefficiency and poor time management will be outlined, and strategies to mitigate the role of these factors in day-to-day practice will be discussed and examined by the group.

T101307 13:45–14:45

Borderline Personality Disorder: Strategies for self-management and resiliency James Goertzen, MD, MClSc, CCFP, FCFP, Thunder Bay, ON 716A MTCC

Learning Objectives: 1. apply strategies for the effective management of patients with a borderline personality disorder 2. increase resilience while providing care to patients with a borderline personality disorder 3. develop physician-patient relationships that encourage patients with a borderline personality disorder to increase their self-

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE management skills Description: Patients with a borderline personality disorder struggle with instability in self-image, affect regulation, impulse control, and interpersonal relationships. Frequent self-injury and testing of patient-physician boundaries can lead to frustration and/or burnout. Effective management strategies incorporate principles from dialectical behavioural therapy that can be readily embraced by family physicians and applied within their clinical settings. Key is developing a supportive physician-patient relationship where appropriate boundaries are defined, ongoing negotiation becomes a key feature, and mutual respect by both physician and patient is nurtured.

T101354 13:45–14:45

Mental Health and Workplace Challenges Ellen Anderson, MD, MHSc, Sooke, BC; Nick Kates, MB, Dundas, ON; Joel Andersen, MD, CCFP, Sudbury, ON 401 MTCC

Learning Objectives: 1. use a clear framework for assessment and treatment of a work-related mental health problem 2. use strategies to determine whether and when a medical leave of absence is warranted 3. apply principles to develop a treatment plan while collaborating with the patient and completing necessary paperwork Description: Family physicians are dealing with work-related mental health issues on a daily basis. This can include assessing the impact of a work-related issue on individuals‘ well-being and helping them cope with workplace-engendered stress, determining whether and when a medical leave of absence is warranted, supporting individuals who have lost their job, helping individuals return to work after a medical leave, helping individuals with mental health problems who have been out of the work force retrain and rebuild their confidence, and completing necessary forms and paperwork. Using a case-based format, we will discuss an approach to the assessment and treatment of work-related mental health problems, which will provide practical tips for a family physician when handling any of these situations. It will include taking a work history, the different ways in which workplace factors can affect someone‘s mental health, assessing the severity of symptoms, when and how to manage time away from the job, and how to assist someone return to work after a period of time away. We will also offer tips on completion of necessary paperwork.

T101502 13:45–14:45

Maintaining Hope Through the Cancer Journey Ian MacDonald, MD, CCFP, FCFP, LM, Fredericton, NB 711 MTCC

Learning Objectives: 1. recognize patients‘ personal cancer experiences 2. recognize the doctor‘s role in supporting cancer patients 3. recognize the role that doctors have played in destroying Hope for cancer patients Description: I am a family physician, and have been a cancer patient. I describe some of the issues I faced early in my cancer journey. I have had surgery, chemotherapy, and radiotherapy for pancreatic cancer. Having been extremely fortunate to survive this cancer, I became a volunteer with Cancer Connection. In that role I have supported over 100 cancer patients, as they needed to talk to someone who had ”been there.” I became very distressed by the stories from these people. They described how their hope was destroyed by their attending physicians, the very doctors who should have offered support, empathy, and hope for their patients. I offer direct quotes from these patients illustrating their frustrations. I then talk about setting goals and maintaining hope. I wish to make family doctors aware of how their comments and attitude can destroy hope for their cancer patients. This could be a stand-alone talk or part of a workshop to discuss these issues.

T101662 A Field Note Practicum: Challenges assessing postgraduate trainees in CanMEDS–FM roles and 13:45–17:30 six skill dimensions across the competency continuum Perle Feldman, MDCM, CCFP, FCFP, MHPE, Toronto, ON; Viola Antao, MD, CCFP, DFCM, Toronto, ON; Barbara Stubbs, MD, CCFP, FCFP, Toronto, ON 707 MTCC Learning Objectives: 1. discuss the challenges with assessment, in particular using Field Notes as an assessment tool 2. assess residents, particularly remedial residents and high-performing residents, in non-expert and non-communicator roles 3. apply framework to assess postgrad trainees using the CanMEDS–FM roles and the CFPC six skill dimensions, and its links with the competency curriculum Description: The assessment of postgrad trainees within a CBC using Field Notes has garnered much focus and attention over the past five years.

Assessment of outlier residents (either remedial or excellent) in the less intuitive roles (non-expert, non-communicator) continues to pose challenges for teachers. This workshop uses a Field Note tool for teachers, developed at University of Toronto, for formative feedback on clinical interactions. The tool combines the CanMEDS–FM roles and the CFPC‘s six skill dimensions as criteria to assess performance. In this workshop we will focus on the evaluation of candidates at different levels of skill and training with respect to an office-based clinical encounter. We explore the translation of these evaluating criteria to competencies established within a Triple C curriculum. Attention will be given to use of field notes with remedial and exceptionally strong residents. During the workshop, teachers will practise assessment with the tool using case-based videos. Our aim is to provide a better understanding of the assessment process in a competency curriculum, particularly of the more elusive CanMEDS–FM roles. fmf.cfpc.ca

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T102394 Improving Family Medicine Research With Standardized Reporting Guidelines 13:45–15:45 Aaron Orkin, MD, MSc, MPH, CCFP, FRCPC, Toronto, ON; William R. Phillips, MD, MPH, Seattle, WA; Lars E. Peterson, MD, PhD, Lexington, KY; Nick Pimlott, MD, PhD, CCFP, Toronto, ON; and the Annals of Family Medicine Editorial Team 712 MTCC Learning Objectives: 1. identify and describe reporting guidelines relevant to conducting, interpreting, and using family medicine research in practice, education, research, and policy 2. explore as producers and consumers of research the strengths and weaknesses of using reporting guidelines 3. improve family medicine research, reporting, peer reviewing, and practice through use of reporting guidelines

T102762 13:45–14:45

THURSDAY • JEUDI

Description: Reporting guidelines have been established for most qualitative, quantitative, and review methods in health research. However, the growing number of such guidelines can leave researchers drowning in alphabet soup: CONSORT for randomized trials, STROBE for observational studies, PRISMA and MOOSE for systematic reviews and meta-analyses, SQUIRE for quality improvement studies, SAMPL for statistical reporting. Standardized reporting guidelines were created to improve the description of original research methods and results, to help in the critical appraisal of literature, and in the synthesis of research. These guidelines are largely an unproven technology with an inadequate evidence base.Use of these guidelines might improve family medicine research, but they might also be obstructive or inappropriate in some circumstances. How can family physicians and researchers use reporting guidelines to design better studies, write better papers, and interpret the literature for application in their practices? Editors of Annals of Family Medicine and Canadian Family Physician will present a summary of essential reporting guidelines applicable to family medicine research and provide resources to find and utilize appropriate guidelines. We will illustrate the do‘s and don‘ts of working with reporting guidelines to strengthen study design, compose effective research reports, and write effective peer reviews. Instead of using reporting guidelines as a cookbook for research and writing, we will suggest strategies to use these tools to help your work flourish. We will break into groups to explore and critique the reporting guidelines that are most relevant to research in family medicine. Participants will interactively critique the reporting guidelines that apply to their own research, and discuss how they have made best use—sometimes selective use—of the guidelines. Are reporting guidelines useful tools in family medicine research, or do they stifle scholarly creativity and sterilize literary style? We will close with a conversation on reporting guidelines in family medicine research and publication. Participants will hear arguments for and against the use of standardized reporting guidelines in the variety of methods and topics characteristic of family medicine research and contribute their own perspectives and experiences to the discussion.

Care at the End: Transitioning to a palliative approach for frail elders at home Jay Slater, MD, CCFP, Vancouver, BC 714AB MTCC

Learning Objectives: 1. identify some of the challenges faced when palliating patients with chronic disease in the home setting and consider strategies to mitigate them 2. describe the ”tool kit” that assists the clinician in providing good home-based palliative care (assessment aids, equipment, medications) 3. apply palliative approaches to common conditions at end of life and use cases to highlight strategies for symptom management in common diseases Description: Care of frail elders is often made challenging by any one or a combination of multimorbidity, cognitive decline, functional deficits, and dwindling support networks. A patient-centred approach to primary care for these elders, the ”medical home,” is an effective and compassionate way to provide service. As their health inevitably deteriorates over time, the focus of care typically evolves from a chronic disease model to a more palliative approach. A significant number of seniors say that their preference is to remain in their home and to ultimately die there. Unfortunately, gaps in care systems and the challenges of providing comprehensive home care are such that some patients end up spending their last days in acute care or in nursing homes. Addressing those gaps and challenges is important not only for enhancing the quality of elders‘ experience but also for the health system as a whole, which is facing increasing demographic demand and limited budgets. We will discuss one approach to home-based care, the Home ViVE (Home Visits to Vancouver‘s Elders) program that is a collaborative, multidisciplinary primary care team. The practical issues of balancing patient preferences, their competency to make health care decisions, and the provision of safe, appropriate care at home will be reviewed. This 45-minute session will include both a large group presentation and small-group, case-based discussions to identify the challenges related to supporting end-of-life care in the home. It will focus on practical tools and approaches to caring for older adults (and their families) as their condition progresses.

T102818 13:45–14:45

Traditional Healing Practices Within the Western Medical System Marlyn Cook, MD, CCFP, Winnipeg, MB

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE 703 MTCC

Learning Objectives: 1. discuss traditional healing practices that family physicians with aboriginal patients can use 2. discuss the negative effect of residential schools on the health status of aboriginal people 3. discuss racism in the health care system and ways to address it Description: In many aboriginal communities in Canada today, there are traditional healing programs being established to run in parallel with the Western medical systems. Many health care practitioners do not have an understanding of these programs or of how the healers work. Traditional healers look at all aspects of the person they are helping: the body, the mind and the spirit. They use ceremonies and medicines from the Earth to help the person heal. There were many residential schools across Canada, affecting many aboriginal people. The negative effects of these schools on the person, the family, and the community were profound and contributed to poor health, early death, and suicides. Racism exists in the health care system, and if we cannot acknowledge this fact, we cannot address it. This fact will be discussed, and ways of dealing with it will be brought forward. Dr Marlyn Cook is a First Nations physician as well as a traditional person who carries the sacred pipe and the sweat lodge. She is a sundancer and has danced for the last 24 years. She will utilize this traditional knowledge to educate and share this healing system that has been in Canada for thousands of years.

T102837 13:45–14:45

Medical Education Research 101 Revisited: An overview of the basics of methodology and design Shelley Ross, PhD, Edmonton, AB; Douglas Archibald, PhD, Ottawa, ON 710 MTCC

Learning Objectives: 1. describe some common methodologies and research designs for medical education research 2. identify the most appropriate methodologies and designs for participants‘ own research questions 3. apply ideas and examples from the workshop to medical education projects Description: Many preceptors, residents, and clinical teachers have an interest in medical education research but do not know how to start to answer their research questions. Choosing a methodology and a research design can be overwhelming. If you are nodding right now, this workshop is for you! The first half of this workshop is an overview of the most common research methodologies and research designs used in medical education research. Both quantitative and qualitative methodologies will be presented and briefly described, and some sample research questions will be included for each methodology and design presented. A very brief overview of possible statistics will be incorporated. In the second half of the workshop, participants will work in small groups to discuss research questions and choose appropriate methodologies and designs to answer those research questions. The presenters will aim to group the participants by types of research questions (and, consequently, by possible methodological approaches). A large group discussion near the end of the session will include a question-andanswer exchange between participants and presenters to clarify areas of concern. Presenters will also provide some possible resources that participants can explore at their own institutions to help support their medical education research. Participants will leave the workshop with a preliminary plan for a medical education research project.

T103009 13:45–14:45

Top 10 Apps for Your Smartphone or Tablet: Teaching and learning in the office Les 10 meilleures applications pour votre téléphone ou votre tablette : Enseigner et apprendre en cabinet

Andrew Sparrow, MD, CCFP, Toronto, ON; David Esho, MD, Toronto, ON HALL F MTCC

Learning Objectives: 1. identify smartphone/tablet applications that will help primary health care providers with both clinical practice and teaching 2. use applications to make clinical practice more efficient and fun in a working and teaching environment 3. use tools to identify new apps that may be of use to physicians on an everyday basis Description : This session will review the use of technology tools such as websites and phone or tablet applications that might help you with managing clinical practice and teaching. In this interactive session, we will demonstrate several solutions and hear from other participants how they are already using technology for this purpose. We will be highlighting solutions you can use with your patients, your learners, and yourself.

Examples include clinical tools, useful recommendations you can give your patients, and apps you can use to aid with teaching. This session will be suitable for participants at all levels of familiarity with technology. You are welcome to bring your smartphone/tablet to the session and we will make use of these during the session.

Objectifs d’apprentissage : 1. identifier les applications pour téléphones intelligents et tablettes qui aident les professionnels de la santé en soins primaires dans leur pratique clinique et pour l’enseignement 2. utiliser des applications pour rendre la pratique clinique plus efficace et amusante dans un milieu de travail et d’enseignement 3. utiliser des outils pour identifier de nouvelles applications qui pourraient être utiles aux médecins sur une base quotidienne

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Description : Cette séance examinera l’utilisation d’outils technologiques comme des sites Web et des applications pour téléphone ou tablette, qui pourraient vous aider dans la gestion de votre pratique clinique et dans l’enseignement. Pendant cette séance interactive, nous ferons la démonstration de plusieurs solutions, et d’autres participants expliqueront de quelle façon ils utilisent la technologie à ces fins.

Nous mettrons l’accent sur des solutions auxquelles vous pourrez avoir recours, pour vous ou dans vos interactions avec vos patients et vos apprenants. Citons à titre d’exemple les outils cliniques, les recommandations utiles que vous pouvez faire à vos patients et les applications dont vous pouvez vous servir pour enseigner. Tous peuvent participer à cette séance, sans égard au niveau de familiarité avec la technologie. Vous pouvez apporter votre téléphone intelligent ou votre tablette, que nous pourrons tester pendant la séance.

T115045 13:45–17:30

Rural Educators' Forum Alain Papineau, MD, CCFP, FCFP, New Richmond, QC; Colin Newman, MD, CCFP, Twillingate, NL; Ruth Wilson, MD, CCFP, FCFP, Kingston, ON, Kathy Lawrence, MD, CCFP, FCFP, Regina, SK 709 MTCC

T102796 14:15–14:45

Vertigo Diagnosis and Management: A family physician‘s perpective Vikram Dalal, MD, CCFP (EM), FCFP, London, ON; Andrew Maeng, MD, London, ON 801AB MTCC

Learning Objectives: 1. develop stepwise approach to differential diagnosis and distinguish between central and peripheral causes of vertigo 2. identify functional anatomy of the vestibular system and review common vestibular physical examinations 3. describe common medical treatment of benign causes of vertigo, including vestibular rehabilitation therapy

THURSDAY • JEUDI

Description: This year’s Forum will be focusing on the work currently being led by the Advancing Rural Family Medicine Canadian Collaborative Taskforce (Taskforce). Attendees will be given the opportunity to provide their perspectives on findings to date from the environmental scan describing rural medical education offered at both the undergraduate and postgraduate levels of training and provincial policies on recruitment and retention. In addition, participants will provide feedback on preliminary results from the qualitative study conducted to understand experiences of rural family physicians in Canada. The Forum is intended to allow participants to share and learn about leading best practices in rural education and training and to identify gaps. The session aims to support participants in generating recommendations for action to inform the work of the Taskforce.

Description: ”Dizziness” is among the most common reasons for which patients present to the family doctor‘s office and the emergency department. The report of symptoms can be vague, inconsistent, or unreliable such that life-threatening disorders can masquerade as benign disorders, and tests ordered to screen for life-threatening conditions are often insensitive. Of the various causes of dizziness, vertigo is the most common and often self-limiting. Vertigo can be caused by both peripheral and central etiologies, with the latter being more predominant among the elderly. Vertigo is a symptom that predominantly arises from an acute asymmetry of the vestibular system. Despite vagueness in the history, the patient‘s description, as well as collateral information, is the most sensitive in making the diagnosis of vertigo. Physical examinations, including special manoeuvres, help to further narrow or clinch the diagnosis.

It is a symptom that is best managed by family and emergency room physicians. In most cases there is never a need for further referrals or more intense investigations. This session for the family and emergency physician focuses on review of the functional anatomy of the vestibular system, as well as on key features of the history and physical examinations that will allow physicians to efficiently separate patients into a ”peripheral vestibular” or a ”central stroke” category with near-perfect accuracy. For the more benign causes of vertigo, this session will review common medical management, as well as vestibular rehabilitation therapy.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T101160 15:15–15:45

EBM for Clinical Practice 1: Diagnosis David Chan, MD, CCFP, MSc, FCFP, Hamilton, ON; Henry Siu, MD, CCFP, Oakville, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. derive EBM values such as specificity, sensitivity, and likelihood ratios when given a 2x2 table 2. use EBM values to justify physical examination, ordering diagnostic tests, and diagnosis 3. help patients understand how the evidence applies to their diagnosis Description: Finding EBM far-fetched, irrelevant, and impractical in clinical practice? Feeling overwhelmed and confused by the constantly changing guidelines? Afraid of the math involved in EBM? Using clinical scenarios, online tools, and calculators, this workshop will work through basic concepts of the principles of evidence-based practice including 1) prevalence, incidence, and pre-test likelihood—why do they matter? 2) understanding diagnostic tests and clinical uncertainty—review of sensitivity and specificity, use of likelihood ratios in clinical practice; 3) how to determine the clinical utility of a physical examination maneuver or diagnostic test for diagnosis; and 4) how to explain these numbers to patients. This workshop aims to familiarize and demystify EBM vocabulary that can often paralyze a clinician during routine practice. We will show you how these principles can be effectively incorporated into your clinical practice.

T100795 15:45–16:15

EBM for Clinical Practice 2: Therapy David Chan, MD, CCFP, MSc, FCFP, Hamilton, ON; Henry Siu, MD, CCFP, Oakville, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. be comfortable deriving advanced EBM values such as number needed to treat, relative risk and odds ratios 2. be more rational in making therapeutic decisions for common medical conditions 3. be comfortable in helping patients understand how the evidence applies to their treatment Description: This session builds on the foundations and definitions taught in “EBM for Clinical Practice 1: Diagnosis.” This session will help the clinician become comfortable with identifying the important EBM concepts and values that most impact therapeutic decisions. Using clinical scenarios, online tools, and risk calculators, this workshop will work through more advanced concepts of the principles of evidence-based practice including effect size and how it can it be expressed; comparing treatments—use of NNT and NNH; confidence intervals—why it matters; and odds ratio and relative risk—what these values mean; and how to explain these numbers to patients. This workshop aims to familiarize and demystify EBM vocabulary, which can often paralyze a clinician during routine practice. We will show you how these principles can be effectively incorporated into your clinical practice.

T101640 15:15–16:15

Smoking Cessation in Primary Care: Safe and effective prescribing for patients with co-morbidities Peter Selby, MD, CCFP, FCPP, Toronto, ON 801AB MTCC

Learning Objectives: 1. apply smoking cessation approaches that are appropriate for primary care practices 2. appropriately prescribe and titrate smoking cessation pharmacotherapy 3. tailor smoking cessation support for patients with mental health problems or other physical co-morbidities or both Description: Tobacco dependence is the leading cause of preventable death in Canada, killing nearly 37,000 Canadians every year. Primary care settings are optimal for addressing tobacco use; however, a lack of specialized knowledge in smoking cessation interventions poses a challenge to adapting and tailoring psychosocial and pharmacological approaches for tobacco dependence treatment. Additionally, primary care physicians often see patients with complex co-morbid conditions, such as depression and COPD, for whom quitting smoking requires a personalized approach. This dynamic and interactive session will give family physicians practical, relevant knowledge and skills to incorporate evidence-based approaches to tobacco dependence treatment in their practice, with particular emphasis on adapting and tailoring pharmacotherapy for patients with co-morbid conditions. Family physicians will leave the session with a better understanding of how to recommend and prescribe pharmacotherapy for tobacco dependence and explore evidence-based approaches for patients with mental health problems and COPD. This session emphasizes learner engagement, interaction, and practice though large and small group discussions, case-based learning, and reflective exercises. Workshop participants will receive links to clinical tools and resources to facilitate sharing with colleagues and community stakeholders.

T101965 15:15–16:15

6 for 6: Building a scholarly research program for rural and remote family medicine faculty – lessons learned two years down the road

Wendy Graham, MD, CCFP, Channel-Port-aux-Basques, NL; Patricia McCarthy, St John‘s, NL; Shabnam Asghari, St John‘s, NL 710 MTCC

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Learning Objectives: 1. recognize barriers for rural and remote family medicine physicians who engage in scholarly research 2. describe the planning, design, and implementation phases of the 6 for 6 program 3. explore strategies for the design and implementation of a scholarly research program in other rural contexts using a participatory action approach

T95570 15:15–16:15

Back to the Future: The family physicians of today meet the family doctors of tomorrow Pierre-Paul Tellier, MD, CCFP, FCFP, Montreal, QC; Kathy Lawrence, MD, CCFP, FCFP, Regina, SK 803B MTCC

Learning Objectives: 1. gain valuable insights on a career in family medicine 2. discuss practice opportunities in family medicine 3. ease the transition into primary care Description: In this session, students and residents have the opportunity to meet and speak with recipients of the Reg L. Perkin Award, who have been named Canada‘s Family Physicians of the Year. This unique event allows students and residents to ask questions regarding worklife balance and easing into practising family medicine, and to discuss the challenges they might face. This session also gives award winners the chance to share their insights and their experiences of starting out in family medicine.

THURSDAY • JEUDI

Description: Family medicine faculty working in rural and remote areas experience barriers to participating in scholarly research, including lack of time, geographic isolation, and limited access to professional development opportunities. Memorial University has responded to these barriers by developing 6 for 6, a scholarly research program tailored to the needs of rural family medicine physicians. Now in its second year of development, this longitudinal program uses a participatory action approach and is designed to minimize the challenges associated with conducting research in rural regions by providing education, support, and resources to rural faculty. Workshop attendees will take part in interactive small group break-out activities and large group discussions related to the development and implementation of a scholarly research curriculum for rural and remote clinical faculty. Participants will be given the opportunity to identify and discuss barriers to research engagement for rural faculty and explore approaches to addressing and accommodating identified needs. Using Memorial University‘s 6 for 6 program as a model, attendees will gain insight into the initial steps of building a curriculum development plan, and discuss strategies and key lessons for designing and implementing research curricula in a rural context.

T102077 Providing Trauma-Informed Care to Patients With Addictions and Other Mental Health 15:15–16:15 Problems in Primary Care Settings Dispenser des soins à des patients aux prises avec une toxicomanie et d'autres troubles de santé mentale en soins primaires tout en tenant compte des traumatismes

Sheryl Spithoff, MD, CCFP, Dip. ABAM, Toronto, ON 718AB MTCC

Learning Objectives: 1. screen appropriately for interpersonal trauma 2. find trauma therapy resources in the community 3. teach basic grounding techniques to patients with post-traumatic stress disorder Description: Many patients with addictions and other mental health problems have a history of interpersonal trauma in childhood (abuse, neglect) and/or in adulthood (intimate partner violence, sexual assault) and suffer from post-traumatic stress disorder (PTSD). Providing trauma-informed care will minimize the risk of re-traumatizing patients and increase retention in treatment. Screening for trauma and connecting patients to appropriate treatment can have a significant positive impact on outcomes. However, most family physicians have had little education and training in trauma and PTSD, and do not feel comfortable with these interventions. In this session, we will review the prevalence of interpersonal trauma and the link with addiction and other mental and physical health problems.

Using cases, we will describe how to offer trauma-informed care, including how to screen for trauma and how to connect patients to trauma therapy resources.

Objectifs d‘apprentissage : 1. dépister les traumatismes interpersonnels de façon appropriée 2. localiser les ressources communautaires pour le traitement des traumatismes 3. enseigner les techniques de base de la prise de conscience de l‘ici et maintenant aux patients souffrant d‘un état de stress posttraumatique

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Description : Nombreux sont les patients aux prises avec une toxicomanie ou d‘autres troubles de santé mentale qui ont subi un traumatisme interpersonnel durant l‘enfance (violence, négligence) et/ou à l‘âge adulte (violence commise par un partenaire, agression sexuelle) et qui souffrent d‘état de stress post-traumatique (ESPT). La prestation de soins qui tiennent compte du traumatisme réduit au minimum le risque de retraumatiser le patient et améliore la rétention thérapeutique. Le dépistage du traumatisme et l‘orientation du patient au traitement approprié peuvent se répercuter de manière significativement positive sur les résultats. La plupart des médecins de famille ont toutefois reçu très peu de formation sur les traumatismes et l‘ESPT, et sont mal à l‘aise face à ce type d‘intervention. Dans cette séance, nous allons examiner la prévalence des traumatismes interpersonnels et de leur lien à la toxicomanie et à d‘autres problèmes de santé mentale et physique. À l‘aide de cas, nous allons décrire comment dispenser des soins qui tiennent compte des traumatismes, y compris la façon de dépister un traumatisme et de mettre le patient en relation avec les ressources qui pourront traiter le traumatisme.

T102162 Keeping Your Elderly Patients Out of Hospital: A physician‘s and a pharmacist‘s insights into the 15:15–16:15 top 10 drug interactions

Michelle Hart, MD, CCFP, MScCH, Thornhill, ON; Pauline Giancroce, BScPhm, RPh, ACPR, PharmD, Toronto, ON HALL G MTCC

Learning Objectives: 1. identify the top 10 clinically significant drug interactions in the elderly and apply this information to practice in order to prescribe more safely and prevent unnecessary admissions to hospital 2. describe the common mechanisms involved in drug interactions, with a focus on QTc prolongation 3. identify system challenges in drug interaction monitoring and discuss possible solutions for interdisciplinary collaboration Description: Drug interactions represent a serious problem that can result in preventable adverse drug events. A growing body of studies are demonstrating an increase in hospital admissions (up to 5 per cent) related to drug interactions.The elderly population is particularly vulnerable, given pharmacokinetic, pharmacodynamic, and physiological changes with aging, as well as the high number of concomitant drugs elderly patients are taking! In theory, drug interactions and adverse drug events are largely preventable. In practice, however, the understanding around the mechanisms causing dangerous drug interactions, as well as the recognition and detection of drug interactions, has been suboptimal. In fact, only in the last few years has the medical community started to focus more on the importance of recognizing drugs that cause QTc prolongation, as an example. This session will review the top 10 clinically significant drug interactions in the elderly and the challenges in identifying drug interactions, and discuss suggestions and solutions for monitoring and prevention through interdisciplinary collaboration.

T102251 Pearls of Diagnosis and Management of STEMI of Different Coronary Territories in the Emergency 15:15–16:15 Department

Vikram Dalal, MD, CCFP (EM), FCFP, London, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. rapidly identify and differentiate between STEMI of different coronary territories, based on an electrocardiogram 2. discuss and evaluate medical management of various STEMI 3. recognize and manage complications of STEMI and review indications for rescue PCI Description: Acute myocardial infarction (MI) accounts for approximately 30% of all acute coronary syndromes. Rapid diagnosis and treatment of MI is one of the hallmark specializations of emergency medicine because emergency departments are a common health care entry point for patients experiencing MI-associated symptoms. Blockage of particular coronary arteries leads to predictable regions of infarction.

Identification of the anatomic distribution of ischemia and/or infarction is an essential step in the diagnosis and subsequent management of ST-elevation myocardial infarction (STEMI), because specific areas of infarction increase the likelihood of certain complications and affect morbidity and mortality. Many hospitals are not equipped with facilities that can perform primary percutaneous coronary intervention (PCI); hence fibrinolytics remain an essential reperfusion treatment option for STEMI patients in most emergency departments. In such situations, American College of Cardiology/American Heart Association guidelines recommend the initiation of fibrinolytics therapy within 30 minutes of a STEMI patient‘s contact with the medical system. Reperfusion outcomes with this therapy, at 30 days post-intervention, are comparable to those with PCI. It is also prudent to note that reperfusion is not always achieved in patients who receive fibrinolysis. For optimal patient care in such situations, familiarization with indications for rescue PCI, which can be done up to 24 hours after fibrinolysis, is then of paramount importance. This interactive case-based workshop, aimed primarily at family physicians working in a smaller/rural emergency department setting, will help participants review medical management and potential complications of STEMI of various coronary territories. We will also review indications for rescue PCI.

T102275 Bedside Ultrasound for the Family Physician 15:15–16:15 Peter Steinmetz, MD, CCFP, Outremont, QC; John Lewis, MD, CCFP (EM), FCFP, Montreal, QC; Sharon Oleskevich (PhD), Montreal, QC 714AB MTCC Learning Objectives: 1. define bedside ultrasound as an adjunct to the clinical assessment of a patient 2. describe 10 common clinical scenarios found in outpatient family practice for which bedside ultrasound can improve diagnostic accuracy 3. recognize how and where to pursue learning activities that will confer proficiency in bedside ultrasound

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Description: The primary care clinician is faced with a wide variety of clinical scenarios for which bedside ultrasound can assist in diagnoses, therapeutics, management, procedures, and, ultimately, improved patient outcomes. Here we will present 10 common outpatient clinical scenarios for which the family physician can use bedside ultrasound as a powerful point-of-care diagnostic tool. Bedside ultrasound in the approach to dyspnea, chest pain, leg swelling, abdominal pain, joint pain, vaginal and pelvic bleeding, vision loss, and kidney injury will be reviewed in a problem-based practical audiovisual presentation of cases managed by the authors. We will also review how family physicians can acquire the skills necessary to safely and effectively use this important clinical tool.

T102278 Top 10 Contemporary Topics in STI Care for the Family Physician / Les 10 meilleurs sujets actuels 15:15–16:15 de soins des ITS pour le médecin de famille Charlie B. Guiang, MD, CCFP, Toronto, ON; Hannah Feiner, MD, CCFP, Toronto, ON; Kent To, MD, CCFP, Toronto, ON HALL F MTCC

Description: In Canada, the rates of chlamydia, gonorrhea, and syphilis have been rising since the late 1990s (1). Although not generally a reportable disease, herpes simplex also continues to be an ongoing sexually transmitted infection (STI) issue. Primary care providers are often the first point of contact for STI screening, diagnosis, and management. This presentation is intended for primary care clinicians involved in STI care (including family physicians, allied health care professionals, residents, and medical students). We aim to explore contemporary topics in STI care using clinical cases and highlighting clinical pearls. We have carefully chosen 10 concise topics in STI care for relevance to office practice, and clearly highlight the take-home messages for each. Where appropriate, differences between provinces/territories will be pointed out. Session participants will gain valuable insight into confidently and safely addressing STI screening, diagnoses, and management, focusing on clinically relevant and up-to-date topics that occur in the office. Beyond the basics of STI care, this inclusive list will provide the tools that will make an impact on patients at risk for STIs and also follow the Public Health Agency of Canada‘s guidelines on sexually transmitted infections. 1) what we don‘t know can harm us ... and others—asymptomatic STIs: testing other at-risk anatomical sites, 2) making sense of new screening for an old foe— syphilis testing and management, 3) miss-me-not—pelvic inflammatory disease (PID) manifestations, 4) treating me right—emerging gonorrhea resistance, 5) doing it right the first time—choosing the right swabs/tests for STIs, 6) widening your lens—increasing hepatitis C virus (HCV) incidence in special populations and identifying who is at risk, 7) risky business—intrauterine device (IUD) use in those at risk for STIs, 8) offering a vaccine shouldn‘t be a pain in the neck—recommending the meningococcal vaccination, 9) can you test me for that?—type-specific herpes simplex virus (HSV) serological testing, and 10) safer options, please—alternative antibiotic options for the treatment of STIs.1. Public Health Agency of Canada; 2013.

THURSDAY • JEUDI

Learning Objectives: 1. address safe antibiotic stewardship in the treatment of STIs: alternative antibiotic use, and gonorrhea resistance and proper treatment 2. identify STIs (syphilis, HCV, HSV, asymptomatic infection/swabbing) requiring attention with respect to testing, interpretation, and identification of those at risk 3. recognize clinical manifestations of PID and identify the appropriate patients for IUDs, while being mindful of STI risk

Objectifs d‘apprentissage : 1. parler de l‘administration sûre et raisonnée d‘antibiotiques dans le traitement des ITS : solutions de rechange aux antibiotiques, et résistance de la gonorrhée et traitement approprié 2. identifier les ITS (syphilis, VHC, VHS, infection asymptomatique/prélèvement avec un coton-tige) qui exigent l‘attention en ce qui a trait aux tests, à l‘interprétation et à l‘identification des personnes à risque 3. reconnaître les manifestations cliniques d‘AIP et identifier les candidates appropriées pour le stérilet, tout en gardant à l‘esprit le risque d‘ITS Description : Au Canada, les taux de chlamydia, de gonorrhée et de syphilis grimpent depuis la fin des années 1990 (1). Quoique non généralement une maladie à déclaration obligatoire, l’herpès simplex continue aussi d’être une infection transmise sexuellement (ITS) problématique.

Les fournisseurs de soins primaires sont souvent le premier point de contact pour le dépistage, le diagnostic et la prise en charge des ITS. Cette présentation est destinée aux cliniciens en soins primaires qui participent aux soins des ITS (soit les médecins de famille, le personnel paramédical, les résidents et les étudiants en médecine). Par l’intermédiaire de cas cliniques, nous entendons explorer les sujets actuels des soins des ITS et mettre en lumière les perles cliniques. Nous avons minutieusement choisi 10 sujets concis pour leur pertinence à la pratique au bureau ou en clinique, et pour chaque sujet, nous avons clairement souligné les messages à retenir. Les différences entre provinces et territoires seront relevées, le cas échéant. Les participants à la séance comprendront mieux comment s’occuper avec confiance et en toute sécurité du dépistage, du diagnostic et de la prise en charge des ITS au bureau ou en clinique, en examinant les sujets pertinents et actuels sur le plan clinique. Mis à part les soins de base des ITS, cette liste inclusive fournit des outils qui auront des répercussions sur les patients à risque d’ITS et est conforme aux lignes directrices de l’Agence de la santé publique du Canada en matière d’infections transmises sexuellement. 1) ce que nous ne connaissons pas peut nous faire du mal... et autres—ITS asymptomatiques : tester d’autres sites anatomiques à risque; 2) comprendre les nouvelles techniques de dépistage pour un ancien

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE ennemi—dépistage et prise en charge de la syphilis; 3) à ne pas manquer—manifestations de la maladie inflammatoire pelvienne (MIP); 4) traitement approprié—émergence de la résistance de la gonorrhée; 5) bien faire les choses la première fois—choisir les bons prélèvements/ tests pour les ITS; 6) élargir votre point de vue—augmentation de l’incidence du virus de l’hépatite C (VHC) au sein de populations spéciales et identifier les personnes à risque; 7) activité risquée—utilisation d’un dispositif intra-utérin (DIU) chez les personnes à risque d’une ITS; 8) offrir un vaccin ne devrait pas être embêtant—recommandation du vaccin méningococcique; 9) pouvez-vous me tester pour ça?—test de dépistage sérologique pour un type spécifique du virus herpès simplex (VHS); 10) des options plus sécuritaires, s’il vous plaît—options alternatives aux antibiotiques pour le traitement des ITS. 1. Agence de la santé publique du Canada; 2013.

T102360 15:15–17:30

Improving the Residency Experience for Our International Medical Graduates Douglas Archibald, PhD, Ottawa, ON 705 MTCC

Learning Objectives: 1. apply a deeper understanding of the cross-cultural challenges that faculty members face when teaching international medical graduate residents 2. discuss clinical teaching tools and possible intervention strategies aimed at increasing the success of the changing demographic of international medical graduates 3. develop approaches to operationalizing these strategies Description: The assimilation and optimal education of international medical graduates (IMGs) continues to be a challenge for residency programs due to areas of cultural discordance between IMGs and the Canadian medical systems. The problems related to cultural discordance are often perceived by residency educators and administrators as communication, collaboration, and professionalism issues. These can be compounded when there is a lack of clinical reasoning skills. In this interactive workshop we will share highlights and examples of existing tools that can help to improve the residency experience for our IMGs and how participants can use these tools in their own teaching environments. Some examples will include the Impact of Cultural Differences on Residency Experiences (ICDRE) questionnaire, which we have implemented across departments in the Faculty of Medicine at the University of Ottawa.

T102616 Concurrent Disorders in Youth 15:15–17:00 Sharon Cirone, MD, CFPC (EM), ASAM (Cert), Toronto, ON; Ellen Anderson, MD, Sooke, BC; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill; Sanjeev Bhatla, MD, CCFP, FCFP, Calgary, AB 717A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. using a developmental framework, practise universal screening, brief intervention, and referral for treatment for youth presenting with concurrent disorders 2. explain connections between early life attachment, developmental trauma, and subsequent mental health and substance use, and how these impact provision of health care 3. create a framework for collaborative treatment planning using locally available resources Description: In a case-based workshop format, we will offer participants an opportunity to understand and practise a practical comprehensive approach to the assessment and treatment of concurrent disorders in children and youth. This approach will include universal screening, taking a developmental, mental health, and substance use history. The workshop will explore the different ways in which attachment issues and trauma can affect a person‘s developmental trajectory, mental health, and substance use. We will also discuss strength-based assessment and collaborative care planning, and offer tips on using locally available resources to support ongoing treatment.

T102442 15:15–16:15

Music Care for Families Living With Dementia Bev Foster, MA, BEd, BMus, ARCT, AMus, Port Perry, ON 711 MTCC

Learning Objectives: 1. demonstrate knowledge of the music care approach 2. identify reasons how and why music, especially singing, work in dementia care 3. utilize Pathways, a comprehensive singing program for families living with dementia Description: The World Health Organization recognizes that dementia will reach epidemic proportions globally in this century. “Too many of Canada‘s baby boomers will spend their retirement years with Alzheimer‘s or caring for someone who has it”—Alzheimer‘s Society of Canada. In Ontario‘s 1999 “Strategy for Alzheimer‘s Disease and related dementias,” it was noted that there was a lack of quality programming in dementia day care. In addition, the importance of providing caregiver respite was the subject of a separate white paper. While there is no surgical or pharmaceutical cure for dementia, research has shown that music, and in particular singing, can have a positive impact on people living with dementia by improving memory and recognition, improving quality of life, and reducing agitation and apathy. Despite the documented research, there is still a lack of high-quality, well-researched programming that can lighten the load and enhance the wellbeing for those with dementia and their caregivers and contribute to the goals of improved health and wellness in the community. Pathways is a comprehensive singing program designed especially for people living with dementia. It consists of 13 thirty-minute videos facilitated by a singing host, a companion activity booklet, and online training modules. Pathways invites engagement and connection for enjoyment and better quality of life. Designed and facilitated by music care experts, the Pathways Singing Program is accessible and easily delivered by family caregivers. The program is flexible in order to adapt to long-term care, hospital, community, day programming, and in-home settings fmf.cfpc.ca

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and does not require participants and caregivers to be musically proficient. This workshop will be advantageous for clinicians who serve families living with dementia and who are looking for meaningful activities and engagement for their patients, especially for those living at home. Through media, music, and results of evidence-based practice, participants will situate music and singing in the context of dementia care literature and experience an innovative singing resource, designed specifically for persons living with mild to moderate cognitive impairment, that can be used by patients and their families.

T102683 15:15–17:00

Exploring Requests to Hasten Death (1) Monica Branigan, MD, MHSc (Bioethics), Toronto, ON; Doris Barwich, MD, CCFP, Delta, BC 717B MTCC

Learning Objectives: 1. describe the current literature regarding desire-to-die statements (DTDS) and requests to hasten death 2. explore evidence-based interventions in responding compassionately to DTDS, including dignity therapy principles, therapeutic communication principles, and others 3. identify and respond to barriers to open conversation

T102890 15:15–16:15

THURSDAY • JEUDI

Description: Requests to hasten death are common in those with life-threatening illness or irremediable conditions. These requests can vary over time and with disease trajectory, symptom load, or perceived burden to others. Importantly, these statements and requests vary significantly regarding their underlying intention. Some patients are expressing a readiness to die; some, a plea to assist with living; and a small minority, a request for physician assistance in hastening death. With the anticipated change in legislation to allow for physician-assisted death, the options in how we might respond to these statements will change profoundly. As baby boomers who value control and autonomy approach aging, chronic illness, and death, these conversations will become more compelling. A compassionate exploration between patient and physician is necessary to help the patient clarify his or her intention, and to help the physician assess the nature of the request; consider interventions to mitigate suffering; or address questions, concerns, or fears.

This exploration itself has the potential to be experienced as therapeutic by the patient. However, many barriers exist—in ourselves and in our institutions—that make these open conversations difficult. Fortunately, resources exist to support these conversations, as well as evidence-based interventions with which we can respond. In this workshop we will begin with a short didactic session, then view and discuss some videos and reflect on cases in small groups. We will brainstorm as a group about emerging best practice in responding to these requests, as well as ways to overcome common barriers to open conversations. This workshop will not focus on questions regarding possible participation in physician-assisted death but rather on the true exploration of a desire-to die-statement.

Presenters will include facilitators from the Canadian Society of Palliative Care Physicians.

Putting on the Oxygen Mask: Coping with compassion fatigue, stress, and burnout in primary care Shailla Vaidya, MD, MPH, CCFP (EM), E-RYT200, Toronto, ON; Heather Van Laare, BSc, BScN, MN, Toronto, ON 715B MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. recognize the symptoms of compassion fatigue, vicarious trauma, or burnout within oneself 2. acquire tools and techniques to better take care of oneself as a primary care provider 3. develop a strategic plan for recovery and well-being Description: Being a primary care provider is hard work and it can certainly take its toll on our lives, and on the care we provide. In this workshop, primary health care providers will become aware of the prevalence and recognize the effects of compassion fatigue on their personal and professional lives. How to differentiate between compassion fatigue, vicarious trauma, moral distress, and burnout will be explained. Participants will develop an understanding of how their own unique situations can contribute to the development of these common states. Participants will then review evidence-based techniques, including mindful movement and compassionate/ loving-kindness meditation, to experience how to restore and rebuild resilience.

T115051 Adapting Accreditation Standards to 21st-Century Medical Education 15:15–17:30 Keith Wycliffe-Jones, MBChB, FRCGP, CCFP, Calgary, AB; Pamela Eisener-Parsche, MD, CCFP, FCFP, CCPE, Mississauga, ON; Judith Scott, MA, Mississauga, ON 703 MTCC Learning Objectives: 1. discuss the ongoing, tri-College (CFPC,RCPSC, CMQ) development of new accreditation standards and processes relating to postgraduate medical training in Canada 2. collect feedback about the new proposed standards and processes for family medicine 3. collect feedback about the new proposed standards and processes for new enhanced skills standards

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Description: The goal of this session is to share and discuss the proposed major changes in both accreditation standards and accreditation processes for core family medicine and enhanced skills residency training. A short presentation will cover the ongoing development process around new accreditation standards and processes for residency training and also updated standards for enhanced skills training in family medicine.

Following the presentation, there will be ample time for questions and feedback on the proposed changes.

T101353 16:30–17:00

Trauma-Informed Primary Care Christina Toplack, MD, CCFP, Halifax, NS; Victoria Winterton, MD, CCFP, FCFP, Owen Sound, ON 802AB MTCC

Learning Objectives: 1. define trauma-informed practice and trauma-specific care 2. learn the impacts of trauma on mental and physical health 3. learn strategies that foster a safe environment for patients and reduce the risk of re-traumatization Description: All family physicians encounter survivors of interpersonal violence. The setting and nature of our work, including examinations and procedures that seem innocuous and routine, can be distressing for patients with unresolved trauma. This distress manifests in a myriad of ways and our responses can either foster growing trust and safety or unwittingly lead to re-traumatization. There are a number of core competencies in sensitive practice that can be learned by family physicians to be used with all patients, and that do not require special training in mental health, psychotherapy, or working with survivors of violence. A trauma-informed health care practice acknowledges the far-reaching effects of trauma on mental and physical health and routinely applies that knowledge in the provision of health care. This approach to primary health care fits in well within a trauma-informed service culture

T102541 17:00–17:30

Minority Stress: Recognizing the signs and reducing the harm Christina Toplack, MD, CCFP, Halifax, NS; Victoria Winterton, MD, CCFP, FCFP, Owen Sound, ON 802AB MTCC

Learning Objectives: 1. define minority stress and its distal (external) and proximal (internal) elements 2. recognize the mental and physical health presentations of minority stress in primary care 3. identify strategies to reduce health disparities related to minority stress and to foster resilience, at the individual patient, practice, policy, and social levels Description: Meyer‘s minority stress theory (1995) suggests that difficult social situations cause chronic stress in minority individuals that builds over time, resulting in negative health outcomes. The theory has three basic tenets: Minority status leads to increased exposures to distal (external) stressors, such as direct experiences of rejection, prejudice, discrimination, and violence Minority status leads to increased exposure to proximal (internal) stressors, such as concealment of one‘s minority identity, internalized negative beliefs about oneself and one‘s minority group, mistrust of others, and fear of further victimization—due to distal stressors Minority individuals suffer adverse health outcomes due to exposure to distal and proximal stressors Numerous empirical studies—focusing mainly on racial and sexual minority groups—have tested these tenets and confirmed that minority stress helps to explain coping strategies and health behaviours that lead to increased levels of high blood pressure, type 2 diabetes, depression, anxiety, posttraumatic stress disorder, harmful involvement with substances, higher HIV rates, etc. Attachment and health-seeking behaviour are also affected in the presence of minority stress.

These studies also identify factors that foster resilience, such as affirming identities, development of strong community connections, and advocacy. Teaching patients about the biopsychosocial nature of minority stress using strengths- or affirmative-based and harm-reduction primary care strategies will be discussed.

T95470 Managing Challenging Behaviours in Dementia Care: The rational use of antipsychotics, 16:30–17:30 benzodiazepines, and more

Linda Lee, MD, MClSc(FM), CCFP, FCFP, Kitchener, ON; Tejal Patel, BScPharm, Pharm D, Waterloo, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. review common challenging behaviours in dementia care and an approach to medication management when necessary 2. describe the rational use of antipsychotics and benzodiazepines, and practical strategies for antipsychotic and benzodiazepine withdrawals Description: With the aging Canadian population and estimates of approximately one-quarter of persons over age 65 suffering from either mild cognitive impairment or dementia, family physicians will be increasingly challenged to manage behavioural and psychological symptoms associated with these conditions. This session will provide practical tips on medications used to manage common neuropsychiatric symptoms in the senior who is cognitively impaired.

T99991 The Carter Case: How does it affect our palliative care practice?

16:30–17:30 Implications de l‘arrêt Carter sur la pratique clinique en soins palliatifs

Edith Larochelle, MD, LLB, Quebec, QC fmf.cfpc.ca

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HALL F MTCC

Learning Objectives: 1. explain the main concepts of the Supreme Court Carter case 2. identify the rights and obligations of physicians regarding physician-assisted death 3. apply the above concepts to common situations in palliative care Description: This presentation aims to inform participants about the details and implications of the recent Supreme Court of Canada decision (the Carter case) in palliative care practice. Through interactive case discussions we will discuss the details of physicians‘ rights and obligations with respect to physician-assisted death.

Objectifs d‘apprentissage : 1. expliquer les principaux concepts de l‘affaire Carter entendue par la Cour suprême 2. nommer les droits et obligations des médecins en matière d‘aide médicale à mourir 3. appliquer les concepts ci-dessus aux situations courantes en soins palliatifs

T100707 16:30–17:30

Happy Feet: Managing the diabetic foot Mark Karanofsky, MDCM, CCFP, Montreal, QC; Michael Yan, BMedSc, MD, CCFP, Edmonton, AB HALL G MTCC

Learning Objectives: 1. demonstrate a quick, easy, and validated approach to screening and classification for the high-risk foot 2. assess an ulcer in a diabetic patient and select appropriate dressings, devices, and treatments for initial office management 3. select appropriate footwear and community resources for primary and secondary ulcer prevention

THURSDAY • JEUDI

Description : Cette présentation vise à renseigner les délégués sur les détails et les répercussions de la récente décision rendue par la Cour suprême du Canada (affaire Carter) sur la pratique des soins palliatifs. À l'aide de discussions de cas interactives, la séance traite des détails quant aux droits et aux obligations des médecins en matière d‘aide médicale à mourir.

Description: Patients with diabetes are at high risk of foot complications including neuropathy, deformity, ulcers, and, ultimately, amputation.

Family physicians can help prevent such outcomes by screening for early changes of the diabetic foot and instituting protective measures. Some patients may already have foot ulcers and/or infection upon presentation. This workshop will cover an approach to screening for the diabetic foot, techniques and common dressings for initial office management of diabetic foot ulcers, and strategies for prevention of primary and recurrent foot wounds.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE T100352 16:30–17:00

I Want to Be Trans-friendly: The basics of transgender medicine Ted Jablonski, MD, CCFP, FCFP, Calgary, AB 501 MTCC

Learning Objectives: 1. define ”transgender” 2. review the basics of male-to-female and female-to-male transition (hormonal/surgical) 3. debate the concept of being ”trans-friendly” Description: While most practitioners want to be ”trans-friendly,” many find this area of medicine very challenging. Even basic diagnoses, definitions, and wording can make simple communication fraught with mistrust and confusion. Most practitioners want to maintain a therapeutic relationship with their patients during and after transition but sometimes get left out of this ”speciality area” due to perceived disinterest or miscommunication. This presentation is geared for all practitioners who just want to be more comfortable with the basic fundamentals of transgender medicine. This review will provide education for practitioners who wish to better understand and communicate with their patients so as to remain an integral part of their ongoing medical care. The fundamentals of male-to-female (MTF) and female-to-male (FTM) transition (hormonal and surgical) will be reviewed. Hopefully many pearls will be presented to assist all attendees in becoming more ”trans-friendly.” Dr Ted Jablonski is a family physician based in Calgary, Alberta, where he is currently in full-time practice within an innovative, inter-disciplinary community family practice. In addition to family medicine, Jablonski does consultancy work in men‘s health (working with urologist Dr Jay Lee) and sexual and transgender medicine for Southern Alberta and central British Columbia at the Jablonski Sexual Health Clinic in Calgary. Dr Jablonski has a special interest in CHE for physicians, medical professionals and the public, and has been involved in the creation and delivery of a wide range of programs at provincial, national, and international levels. Ted is a sought-after speaker, trainer, media spokesperson, and educator with many conference, radio, television, and video credits.

T101420 17:00–17:30

Meeting the Reproductive Needs of LGBTQ Families Carrie Schram, MD, CCFP, Toronto, ON 501 MTCC

Learning Objectives: 1. describe how Canadian reproductive legislation applies to people who wish to have children outside of traditional heterosexual relationships 2. reflect on the challenges LGBTQ people may encounter when trying to conceive and develop compassion for their unique experiences 3. assist and support LGBTQ patients who wish to have children through education and counseling about their reproductive options Description: With advances in reproductive technology and greater societal acceptance, increasingly more LGBTQ people are having children. 1 In 2011, there were over 64,500 same-sex couples in Canada, and 9,600 children age 24 and under reported living with same-sex parents.

2 Family physicians are often the first point of contact for people wishing to conceive and are uniquely positioned to support their LGBTQ patients who wish to have children. Therefore, it is important that family physicians are aware of Canada-wide legislation that directly impacts the ability of LGBTQ people to conceive and to have general knowledge about the challenges this population may face when seeking reproductive assistance.

Some LGBTQ people conceive with fertility partners outside of the medical system; knowledge of this practice is valuable as it allows family physicians to assist with risk management, offer practical advice, and maintain open dialogue and supportive relationships with their patients. 1. Moskovtsev SI, Dacanay D, Baratz A, Sharma P, Glass K & CL Librach. Significant increase in utilization of donor sperm by lesbian couples after legalization of same sex marriages in Ontario. Fertil Steril 2013; 100(3):S67. 2. Statistics Canada http://www12. statcan.gc.ca/census-recensement/2011/dp-pd/tbt-tt/Rp-eng.cfm?

T101198 Cognitive Behavioural Therapy for Anxiety and Depressive Disorders: Clinical pearls for family 16:30–17:30 physicians Thérapie cognitivo-comportementale pour les troubles anxieux et dépressifs : précieux conseils cliniques pour les médecins de famille

Casandra Wendzich, MD, CCFP, Cayuga, ON 718AB MTCC

Learning Objectives: 1. identify the key components of CBT for various anxiety and depressive disorders 2. model and guide patients through progressive muscle relaxation as well as box breathing relaxation techniques 3. identify when CBT is appropriate as a first-line therapy Description: As family physicians are first line in the identification and treatment of anxiety and depression, I will present a summary of the clinically helpful and key components of cognitive behavioural therapy as it applies to the various anxiety and depressive disorders. This presentation will provide an overview of the major and key components of CBT for depressive disorders as well as anxiety disorders that include generalized anxiety disorder, social phobia, obsessive-compulsive disorder, specific phobia, panic disorder, and health anxiety (post-traumatic stress disorder will not be covered); clinical pearls for family physicians facilitating CBT, which will include but will not be limited to when CBT is appropriate as a first-line therapy; a list of websites and/or workbooks/books that physicians can recommend to their patients with fmf.cfpc.ca

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the aforementioned disorders; a description of as well as in-session audience participation in box breathing and progressive muscle relaxation exercises that can be modeled and taught to patients. This presentation will not address pharmacotherapy.

Objectifs d‘apprentissage : 1. identifier les éléments clés de la thérapie cognitivo-comportementale à l‘égard de différents troubles anxieux et dépressifs 2. faire la démonstration pour les patients de la technique de relaxation musculaire progressive et de respiration 4-4-8 et les guider lorsqu‘ils en font l‘essai 3. définir à quel moment une thérapie cognitivo-comportementale est adéquate comme traitement de première intention

T101334 16:30–17:30

Untangling the Helix 2015: Genomics for primary care providers June C. Carroll, MD, CCFP, FCFP, Toronto, ON; Shawna Morrison, MS, CGC 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. discuss results of direct-to-consumer genetic tests, limitations, and next steps, as well as prenatal screening options with patients 2. identify patients at increased risk of breast and ovarian cancer, and discuss appropriate screening and management including genetic counseling 3. find high-quality genomics educational resources appropriate for primary care

THURSDAY • JEUDI

Description : Comme les médecins de famille sont les intervenants de première ligne en matière d‘identification et de traitement de l‘anxiété et de la dépression, je présenterai un résumé des éléments clés et utiles d‘un point de vue clinique en ce qui a trait à la thérapie cognitivocomportementale, car elle s‘applique aux différents troubles anxieux et dépressifs. Dans cette présentation, je donnerai un aperçu des principaux éléments clés de la thérapie cognitivo-comportementale appliquée aux troubles dépressifs et anxieux, ce qui comprend le trouble d‘anxiété généralisé, la phobie sociale, le trouble obsessivo-compulsif, la phobie spécifique, le trouble panique et l‘anxiété face à la santé (l‘état de stress post-traumatique ne sera pas traité); des précieux conseils cliniques pour les médecins de famille visant à faciliter la thérapie cognitivo-comportementale, ce qui comprendra, sans s‘y limiter, les moments où la thérapie cognitivocomportementale est appropriée comme traitement de première intention; une liste de sites Web et/ou de livres d‘exercice/d‘ouvrages que les médecins peuvent recommander à leurs patients aux prises avec un des troubles mentionnés ci-dessus; une description ainsi que la participation du public, pendant la séance, à des exercices de respiration 4-4-8 et de détente musculaire progressive pouvant être démontrés et enseignés aux patients. La pharmacothérapie ne sera pas traitée dans cette présentation.

Description: This seminar will use a primary care case-based approach to discuss new advances in genomics and their impact on practice. Cases will include direct-to-consumer genetic testing, prenatal genetic testing (non-invasive prenatal testing, microarray), and hereditary breast/ovarian cancer. Participants will be introduced to the GEC-KO website: www.geneticseducation.ca. There will be time for a question-and-answer session so bring your clinical genetics questions.

T101503 16:30–18:00

Healing the Wounds: Stories from where the office meets the street Susan Phillips, MD, CCFP, Kingston, ON 711 MTCC

Learning Objectives: 1. recognize how colleagues have shaped practice to correct for social inequities that harm health 2. translate the role of advocate into practice 3. be inspired about how to blend social activism with family practice Description: What is an advocate to do? Can individual family physicians address social inequities in practice and policy? In this interactive workshop stories of making change will be presented then discussed by all present. Making change means going beyond diagnosis and treatment to consider and act upon the inequities, social circumstances, and life experiences that are so central to health and yet so elusive in clinical practice. We will present stories of practice experiences that build upon those submitted by attendees following a similar workshop offered by the CFPC‘s Equity and Diversity Committee at last year‘s FMF. These examples of how inequities in patients‘ social circumstances shape health will set the stage for discussion. Our aim is to inform and inspire, to develop ways that family physicians can address and ameliorate the inequities that harm and hurt. We will encourage attendees to challenge and to champion methods for family physicians to become agents of advocacy and change.

T101786 16:30–17:30

First Trimester Pregnancy Loss: An office-based approach Hannah Feiner, CCFP, MD, Toronto, ON; Emmanuelle Britton, CCFP, MD CM, Toronto, ON 401 MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. describe an approach to the diagnosis of first-trimester bleeding 2. confidently exclude ectopic pregnancy using the physical exam, ultrasound, and serial blood work as required 3. manage spontaneous abortions in the office with surgical referral where appropriate Description: This presentation will cover an office-based approach to first-trimester bleeding, and the diagnosis and management of spontaneous abortion.

The intended audience is practising family physicians, residents, and medical students, but can also expand to include all allied health care professionals who may care for clients with first-trimester bleeding. Approximately 20 percent of pregnancies are complicated by bleeding before 20 weeks of gestation, and, of these, about half will continue without problems 1) approximately 15 per cent of pregnancies are complicated by spontaneous abortion in the first trimester 2) patients with first-trimester bleeding often present to primary care clinics. This session will present flow chart decision aids for the diagnosis of first-trimester bleeding, as well as the management of spontaneous abortions.

These decision aids will be used to work through several clinical cases with the audience. At the end of this presentation, audience members will demonstrate increased confidence in their diagnosis and management of spontaneous abortions, as well as in their ability to rule out ectopic pregnancies with the judicious use of diagnostic resources.

1. SOGC. Miscarriage & Stillbirth. http://pregnancy.sogc.org/other-considerations/miscarriage-and-stillbirth/. Accessed February 16, 2015.

2. Spontaneous miscarriage in the first trimester. BMJ 2006;332:1223.

T101925 16:30–17:30

Simple Spirometry in Family Medicine Made Even Simpler Tony D‘Urzo, MD, BPHE, MSc, CCFP, FCFP, Toronto, ON 701AB MTCC

Learning Objectives: 1. become familiar with the spirometric criteria for asthma and COPD diagnosis 2. understand how to use a new evidence-based SI algorithm in a timely fashion to interpret a variety of spirograms typical of patients presenting with respiratory complaints in primary care 3. become familiar with the spirometric overlap between asthma and COPD and learn how to distinguish between these conditions using both spirometric and historical data Description: Simple spirometry is recommended for objective confirmation of common conditions like asthma and chronic obstructive pulmonary disease (COPD). Many physicians report a lack of confidence relating to spirometry interpretation (SI). Physicians also report difficulty in distinguishing between asthma and COPD in clinical practice, a challenge that is reflected by an overutilization of first-line asthma therapy for COPD patients in whom this therapy is not recommended. At the present time there is no standardized approach promoted to aid clinicians in the interpretation of spirometry data in day-to-day practice. This session will provide a very pragmatic, evidence-based, and user-friendly approach to SI in primary care. A recently published paper (He X-O, D‘Urzo A, Jugovic P, Jhirad R, Sehgal P, Lilly E. Differences in spirometry interpretation algorithms: Influence on decision making among primary care physicians. NPJ Prim Care Respir Med 2015;25:15008.) by some members of the Primary Care Respiratory Alliance of Canada will be used to describe an approach to SI that can be easily adopted in primary care. This session will focus on using a new SI algorithm developed by primary care physicians to facilitate SI in a manner that recognizes the spirometric overlap between asthma and COPD and that reduces the risk of disease misclassification. A casebased approach will be used to highlight how spirometric overlap might limit the utility of spirometry in distinguishing between asthma and COPD in the absence of a thorough and tailored clinical history.

T102076 16:30–17:30

Primary Care Medical Management Approach to Alcohol Use Disorders (AUDs) Sheryl Spithoff, MD, CCFP, Dip. ABAM, Toronto, ON; Meldon Kahan, MD, CCFP, FCFP, Toronto, ON 716A MTCC

Learning Objectives: 1. be able to provide ongoing counseling and to prescribe medications to patients with AUDs 2. have tools to address underlying mental health problems in patients with addictions 3. recognize when to report a patient for drinking and driving risk Description: The typical family doctor has 25 patients in his or her practice with a moderate-to-severe alcohol use disorder (AUD) or alcohol dependence.

Many of these patients have failed to connect to specialized addiction treatment and are solely under the care of their family doctor. Studies show that, with minimal additional training, family doctors can be as effective as specialized addiction clinics at treating alcohol use disorders. In our session, we will present the evidence-based primary care medical management approach to caring for patients with AUDs. In the model, family doctors give brief ongoing counseling sessions, prescribe first-line medications (naltrexone, acamprosate, and disulfiram) and connect patients to other resources (Alcoholics Anonymous, case management, trauma therapy). We will also give an approach to concurrent mental health problems, including post-traumatic stress disorder. We will discuss drinking and driving risk and the duty to report. We will review how to determine if patients need medical management of alcohol withdrawal and how to provide clinic-based day detoxification.

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T102600 16:30–17:00

A Diagnostic Approach to Strabismus in Children Radhika Chawla, OD, Richmond Hill, ON; Catherine Chiarelli, OD, Toronto, ON 801AB MTCC

Learning Objectives: 1. identify risk factors and signs and symptoms for strabismus in children 2. perform simple in-office techniques for assessment of strabismus 3. differentiate between urgent vs. non-urgent presentations and identify where and when to refer children for further comprehensive evaluation Description: Strabismus is one of the earliest signs of abnormal visual development in children that prompts parents to consult with family physicians. Evaluation is a complex process, considering the various etiologies of strabismus. Emphasis will be placed on differentiating between urgent vs. non-urgent presentations.

T102702 Implementing a Fentanyl Patch Exchange Program: Reducing overdose risk in our communities 16:30–17:00 Jennifer Wyman, MD, CCFP, Toronto, ON; Irene Leibrandt, RPh, BScPhm, Oshawa, ON;

Learning Objectives: 1. recognize the impact of fentanyl diversion/misuse in our communities 2. understand the rationale for a patch exchange program 3. be prepared to implement a patch exchange program in conjunction with community pharmacy and team members Description: Fentanyl accounts for the greatest increase in opioid overdose deaths in Ontario. Even after proper usage, patches contain large amounts of active drug that can be accessed by chewing, smoking, or steeping. Patch diversion and misuse have been identified as major sources of fentanyl access in the community. A patch exchange program requires that patients return their used patches to the pharmacy before they can pick up a new supply. The Durham Region model, implemented in 2014, is closely modeled on those of the North Bay and Peterborough regions. The program involves coordination between prescribers and pharmacists, and has been strongly supported by regional police associations. The rationale, protocol development, roll-out, and practical application in the community will be reviewed.

THURSDAY • JEUDI

Paul McGary, MSW, Oshawa, ON 715B MTCC— Small group interactive workshop – limited seating.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE J102861 16:30–17:30

Mentorat de la prochaine génération de chercheurs en médecine familiale Matthew Menear, PhD, Quebec City, QC; Claire Kendall, MD, PhD, CCFP, Ottawa, ON 710 MTCC

Objectifs d‘apprentissage : 1. décrire la communauté de pratique en recherche que développe la Section des chercheurs du CMFC 2. expliquer les avantages du mentorat en recherche et la stratégie de mentorat développée par le groupe de travail de la communauté de pratique en recherche 3. formuler des recommandations pour améliorer l’accès à un mentorat de grande qualité dans la recherche en médecine familiale Description : Le plan directeur visant la réussite de la recherche en médecine familiale du CMFC identifie le développement des capacités comme domaine stratégique pour le succès de la recherche en médecine familiale au Canada. Un nouveau groupe de travail de la Section des chercheurs a été formé afin de développer la capacité grâce à une nouvelle communauté de pratique pancanadienne en recherche. Un objectif important de cette communauté de pratique sera de faciliter les relations de mentorat entre les médecins de famille et les résidents tôt dans leur carrière de chercheurs ainsi qu’avec des chercheurs chevronnés de différentes disciplines qui peuvent fournir des conseils sur les projets de recherche, la formation et la planification de carrière. Dans cet atelier interactif, les médecins, résidents, enseignants et chercheurs sont invités à une présentation et à une discussion sur l’avenir du mentorat en recherche pour la médecine familiale au Canada.

Dans la première moitié de l’atelier, les membres du groupe de travail présenteront et décriront la communauté de pratique, présenteront des données probantes et des exemples pratiques de l’importance du mentorat en recherche, et dévoileront une stratégie de mentorat pour la communauté de pratique en recherche en fonction d’initiatives précédentes à l’échelle canadienne et internationale. Dans la deuxième partie de l’atelier, les participants travailleront en petits groupes pour fournir des commentaires sur cette stratégie de mentorat et rédigeront des recommandations sur la façon dont la communauté de pratique pourrait davantage aider les cliniciens, les résidents et les éducateurs à accéder à du mentorat de grande qualité afin d’appuyer leurs activités de recherche et leur carrière. Cet atelier aidera à former la nouvelle communauté de pratique en recherche mise en place par la Section des chercheurs.

T106727 16:30–17:30

Research Advocacy: Your voice can make a difference Alan Katz, MB ChB, MSc, CCFP, Winnipeg, MB; Richard Fleet, MD, PhD, CCMF, MU, Quebec City, QC 712 MTCC

Learning Objectives: 1. discuss your research advocacy experiences with like-minded colleagues 2. apply insights from the experiences of others and build collaborative relationships to support your advocacy efforts 3. influence the research advocacy agenda of the CFPC Description: This workshop will explore the current state of research advocacy for family medicine research. Participants will benefit from the experiences of others by sharing their challenges and achievements. The research advocacy action group of the Section of Researchers is looking for your input about their efforts to advocate on your behalf.

TJ108669 Mainpro+ … A New Look, With New Ways to Learn (2) 16:30–17:30 Mainpro+ … Un nouveau look; de nouvelles façons d‘apprendre (2) Eric Wong, MD, CCFP – Regional Educator, Ontario Region / Éducateur régional, région de l‘Ontario, London, ON; Scott MacDonald, MD, CCFP (EM), FCFP – Regional Educator, Atlantic Region / Éducateur régional, région de l‘Atlantique, Bedford, NS 803A MTCC Join us for an informative session on Mainpro+ and the new, practice-centred ways to earn CPD credits for activities you do on a daily basis.

Also, hear the latest updates on fellowship, accreditation, and CACs. The CFPC is committed to providing quality CPD to meet your changing interests and learning needs. Participants may claim an additional Mainpro-M1 credit for this session.

Soyez des nôtres pour une séance d‘information sur Mainpro+ et sur les nouvelles façons d‘obtenir des crédits de DPC pour des activités que vous effectuez au quotidien. De plus, vous pourrez vous renseigner sur les nouveautés concernant le titre de Fellow, l‘agrément et les CCA. Le CMFC s‘est engagé à fournir des programmes de DPC de qualité qui conviennent aux intérêts de ses membres et répondent à leurs besoins en matière d‘apprentissage. Les participants peuvent réclamer un crédit Mainpro-M1 additionnel pour cette séance.

T102409 An Approach to Consumer Health Mobile Apps: What your patients are using and what 17:00–17:30 you need to know

Puneet Seth, BSc, MD, CCFP, London, ON 714AB MTCC

Learning Objectives: 1. discover and categorize the different types of mobile health apps commonly used by patients 2. develop an approach to discussing mobile apps and their current limitations with patients 3. discuss the major advancements in mobile health apps anticipated in the coming years in Canada and beyond Description: Health care delivery is undergoing enormous change. More than ever, patients are demanding to be at the centre of their own health issues—they want to know more about their health, to be involved in making decisions about their health, and to be engaged in their care beyond visits to their doctor. A key enabler of this change has been access to a world of information, made possible through tools fmf.cfpc.ca

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at people‘s fingertips—mobile devices. The ubiquity of apps on smartphones, tablets, and other mobile devices for health-related uses is indisputably on the rise. In fact, a recent US report by Manhattan Research stated that 50 per cent of patients surveyed used mobile devices to gain access to health information. The mobile health—or mHealth—industry today is primarily driven by the patient/consumer, as opposed to the clinician. This presents new challenges to primary care clinicians, who are beginning to see patients coming into their clinics geared with health information stored, viewed, and analyzed on their mobile devices. Presently there is no regulatory body in Canada that overviews health apps and their use, leaving many clinicians in the dark about how they should approach patients using such apps. When a patient asks which app to use to manage a particular medical issue, how should a clinician respond? What apps are out there, and what sources should clinicians turn to if they need more information? And most importantly, are they leaving their patients and themselves vulnerable in any way by using such apps? As medical experts, managers, and leaders of health care delivery, clinicians have a responsibility to respond to such questions with a basic level of knowledge. In this brief session, we hope to help clinicians develop an overall understanding of the consumer mHealth market and will explore practical uses and limitations of such technologies today. In addition, we will explore ideas of what lies ahead in the future of mHealth.

T118642 A 17:45–18:45

Joshua Tepper, MD, MPH, MBA, Toronto, ON; Moderator − Emily Gruenwoldt, CMA, Ottawa, ON 801AB MTCC

Learning Objectives: 1. define the intrinsic relationship between medical professionalism and the pursuit of continuous quality improvement 2. leverage patient engagement opportunities to define quality improvement initiatives 3. identify tools to collect and apply patient data to improve care and enhance quality outcomes Description: This interactive, one-hour ancillary session will engage participants in a discussion about medical professionalism and the intrinsic motivation of physicians to continuously pursue best-quality care. Participants will engage in an interactive, online survey tool to identify and trend matters of medical professionalism relative to family practice. The results of this survey will be contrasted with findings from across the country, and across medical specialties.

This session will heavily emphasize new and emerging approaches to enhance quality improvement in family practice. Dr Joshua Tepper, a family physician and president and CEO of Health Quality Ontario, will describe two tools available to Ontario GPs. The first tool, the Primary Care Practice Report provides physicians with the opportunity to access and leverage confidential, customized patient data to inform quality improvement initiatives within their day-to-day practice. The tool provides insight to inform interventions which can facilitate improved patient flow as well as to compare one patient population to another. The second tool, the Patient Experience Survey, is a validated tool to help family physicians develop a deeper understanding of their patients’ experience in primary care. Participants will discuss how both reports facilitate practice change and enhance patient outcomes.

Participants will also discuss opportunities to advance tools such as these within their own jurisdiction.

THURSDAY • JEUDI

Professionalism and Quality Improvement in Family Medicine: Better has no limit

Participants may claim an additional Mainpro-M1 credit for attending this session

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE

Resident Posters / Affiches des résidents NOVEMBER 12 NOVEMBRE –700 foyer mtcc 640

Iliac Artery Endofibrosis: An elite Canadian triathlete case study

Nazanin Baradaran, MD, Victoria, BC; Robert Brunelle, MD, Victoria, BC; Steven Keeler, MD, CCFP (CASEM), Victoria, BC

Description: Iliac artery endofibrosis, an under-recognized condition, is characterized by intimal thickening of the iliac arteries and most commonly affects elite endurance athletes. Although not limb-threatening, it can have serious career implications in professional athletes. Its relative obscurity is not surprising; to the best of our knowledge no previous Canadian report has been published on the topic so far. A 26-year-old elite male triathlete presented with prolonged abdominal pain and left leg claudication that occurred only after maximal cycling efforts. By the time he sought medical attention, he had withdrawn from a World Cup event due to his symptoms, and was at risk of losing his livelihood as a professional triathlete. Standardized tests were inconclusive. Ultimately, severe iliac artery flow restrictions in flexed hip MRA confirmed the diagnosis. Corrective surgery with unremarkable post-operative course resulted in his return to previous level of competition. Interestingly, he subsequently developed endofibrosis in the contralateral limb, again requiring surgery, putting him in the 15% of athletes to do so. A focused history, physical examination along with specific investigations is essential; including CTA and flexed hip MRA and provocative studies. The condition should be suspected early in any athlete who experiences reproducible claudication symptoms with exercise. With this case study, we hope to highlight the importance of keeping a high index of suspicion in these patients.

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Development of a Rourke Baby Record Parent Resource Mobile App

Laura Butler, MD, Kingston, ON; Heidi Wells, MD, Kingston, ON; Leslie Rourke, MD, CCFP, FCFP, MClinSc, St John’s, NL; Meg Gemmill, MD, CCFP, Kingston, ON; Todd Pardy, BA, St John’s, NL

Description: Context: As evidence mounts regarding sensitive periods in the first 5 years of life for all aspects of future health including learning, personality, physical and mental health, so does the importance of preventive healthcare for infants and young children. Access to parentfriendly, reliable health care resources is a challenge for parents of young children. Parents often wonder about their child’s health, leading to the frequently asked question “Is my baby healthy and growing normally?” Often, well child visits can be overwhelming for parents, and anticipatory guidance may be lost in translation. Objective: This poster will introduce the development of a Rourke Baby Record (RBR) mobile application (app). This app is intended to be a supplementary resource for anticipatory guidance at well baby/well child visits, directed towards parents of young children. After a physician visit, they can review evidence-based information that was discussed by their physician, in layperson terms, and have access to additional parent resources through the app and RBR website (www.rourkebabyrecord. ca). Design: Development of a RBR parent-resources app, where parents can access preventative pediatric health information and resources, following the 2014 RBR. Target Population: Parents of children ages 1 week to 5 years, who will attend well child visits with their family physician or primary paediatrics care provider. Intervention: Evaluation of parent information mobile application on common health issues and anticipatory guidance related to infant and young children through focus groups with parents of children aged 1 week to 5 years.

Outcomes Measured: Satisfaction and feedback survey from participants of focus group. Findings: Will be highlighted. Conclusion: Findings from this study will be used to revise the parent resources for the next revision of the RBR in 2017. This app will appeal to family physicians, paediatricians, nurse practitioners, community health nurses, other primary healthcare providers, students/residents - and of course to parents of young children!

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Quality Road Map: Teaching QI in the community Josephine Lee, MD, Toronto, ON

Description: Context: Quality improvement (QI) in community primary care has been delivered through QI training of family medicine residents and faculty. Our study in 2011 determined the major driving forces and barriers of integrating QI into community primary care. These include leadership, QI tools, capacity building, and continuity. This poster describes how the structure, training, and integration of QI in North York have since evolved to meet these goals. Objective: To evaluate the growth of QI culture through incorporation of QI at various levels of primary care. Design: Implementation of QI initiatives and assessment of their impact through a survey study. Participants: Family physicians in North York, Ontario. Intervention: Local QI interventions, including local QI educators and leaders, department-wide QI initiatives, mentoring, online resources, QI database, data management tools, and departmental rounds. Outcome Measures: Online survey regarding individual QI involvement, current QI drivers/barriers, and assessment of initiatives. Findings: 44 physicians (58.1%) completed the survey.

81% were involved in at least one QI project in the past year, compared to 47% in our 2011 survey. Factors identified as most helpful for QI growth were resident projects, participation in North York Family Health Team initiatives, local mentoring, and QI exchange as part of departmental rounds. The strongest barriers were lack of time, knowledge, and IT support. Conclusions: We demonstrate how implementation of a QI program in community primary care has been achieved through developing local initiatives. We aim to continue spreading this QI culture by aligning with QI at the hospital and North York Family Health Team. We plan to improve upon QI mentorship amongst residents, faculty, and allied health professionals at a local level.

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Driving With Dementia: Comparing physician attitudes and practices when determining fitness to drive Mitch Vainberg, MD, Toronto, ON; Fok-Han Leung, MHSc, MD, CCFP, Toronto, ON

Description: Context: Physicians in Ontario are legally required to report patients thought to be unfit to drive due to medical reasons. With an aging population, reporting drivers with dementia is an important public health action that family physicians will be growingly confronted with.

Objective: This study seeks to assess family physician reporting attitudes and reporting practice for drivers with cognitive impairment.

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reporting practice. Participants: 32 family physicians, including 11 resident physicians, anonymously completed our survey. For our retrospective chart review, we selected records meeting the following inclusion criteria: 1) the records were recorded between July 2009 and July 2014 inclusive; 2) the patient was aged 65 or over within that time span; and 3) a relevant keyword was present somewhere in the record. Instrument: We searched all current electronic medical records of our patients from our database stored in PS Suite. Outcome Measures: We used a previously validated survey measuring attitudes toward driving assessment, selfreporting practice, and basic practice information. Our retrospective chart review measured degree of cognitive impairment and reporting status. Results: For our survey, the majority of family physician respondents (84%) believed that assessing fitness to drive is an important part of their practice. Few respondents (16%), however, were confident in their ability to assess fitness to drive, and the majority (97%) reported wanting further education. Self-report rates for drivers with dementia were high, with over half (56%) indicating reporting drivers with mild dementia, and the majority (81%) answering reporting drivers with moderate dementia.

11 electronic records were analyzed for our retrospective chart review. 10 of these 11 patients had a diagnosis of mild cognitive impairment, and none of them were reported to driving authorities. Conclusions: This study calls for more education for family physicians on their duty to report unsafe drivers with dementia. Reported physician attitudes and knowledge were not in keeping with current driving guidelines.

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Statin Prescribing for Primary Versus Secondary Prevention in Primary Care Practices in Manitoba Felicity Huisma, MD, Winnipeg, MB; Alex Singer, MD, CCFP, Winnipeg, MB

Description: Context: The 2012 Canadian Cardiovascular Society (CCS) Guidelines recommends calculating individual Framingham Risk Scores (FRS) for all women ≥50 and men ≥40 years old to guide the utility of statin therapy. All patients with an FRS ≥20%, and some between 10-20%, are recommended to commence a statin. Since the FRS does not take into account whether the patient has a history of cardiovascular disease, these guidelines do not discriminate patients into primary versus secondary prevention treatment groups, which may be of concern because the evidence for statins in primary prevention is weak. Objective: To determine how well primary care practices in Manitoba are adhering to the CCS guidelines and what proportion of patients prescribed statins is done so for primary versus secondary prevention. Design: Retrospective electronic chart review. Population: All women ≥50 and men ≥40 who have been seen in clinic within the past 18 months. In our original pilot study we assessed one academic teaching unit in Winnipeg, Manitoba. We are in the process of assessing provincial-wide data from a cohort of 180,000 patients, which we will have in time for FMF. Instrument: The Manitoba Primary Care Research Network, which extracts data from a longitudinal database created from de-identified electronic medical records from consenting primary care providers across the province. Results: Our preliminary results found a total of 2363 patients were found to be in the age ranges recommended for routine screening. Of those, 1794 (75%) had an LDL recorded in the past 18 months, and only 507 (28%) had both an LDL and a FRS recorded. Of all patients in the screening age range, 563 (23%) were on a statin, and of those, 415 (73%) were on it for primary prevention, and 148 (27%) for secondary prevention. Conclusions: Given that there is weak evidence to support the use of statins in primary prevention, it is concerning that this group of patients forms the majority of those treated in this preliminary study. There are risks and costs associated with statins, and therefore a more informed discussion between physicians and their patients may be warranted.

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THURSDAY • JEUDI

The Mini-Cog: An easy and effective tool for MCI screening in family practice

Brenna Velker, MD, PhD, London, ON; James P. Mather, MD, CCFP, MSc, London, ON; Darren VanDam, MD, CCFP, London, ON

Description: The Mini-Cog: an easy and effective tool for MCI screening in family practice Velker, B.A.M., Mather, J.P., VanDam, D. Context: Identification of patients with MCI (mild Cognitive impairment) is essential to ensure patients receive adequate support to promote independence, Minimize risks and improve quality of life. Self-identification of memory concerns is unreliable, with only half of individuals with MCI endorsing any Cognitive symptoms. We believe that MCI is being grossly under diagnosed however formal memory testing on all individuals is unrealistic with time constraints during primary care visits. Objective: We believe the Mini-Cog; a validated screening tool incorporated into the annual health exam, is an efficient and practical tool to improve the identification of patients with Cognitive issues. Design: A prospective chart review of patients screened using the Mini-Cog was performed, and compared retrospectively to patients screened the conventional way in the 6 months prior to initiation of the study. Participants: All patients > 65 years of age in our Family Health Team seen for an annual health checkup during the study period. Outcome Measures: Detection of MCI in our practice population. Intervention: Standard practice vs integration of the Mini-Cog test into the annual health exam with follow up MOCA testing as needed based on Mini-Cog score. Results: Of 188 patients screened using the conventional subjective question, only one patient identified concerns with memory, and no diagnoses of MCI occurred. Of the 81 AHEs that occurred during the first PDA cycle, the Mini-Cog was performed in 70% of cases. Of the patients who were investigated, 7% screened positive for MCI and an additional 15% scored in the indeterminate range. When patients in the indeterminate range were brought back for formal neuro-cognitive testing MOCA scores ranged from 24- 28 and additional diagnoses of MCI were made.

Conclusion: Overall, implementation of the addition of the Mini-Cog to the AHE of patient’s age >65 was quick, easy, and resulted in a dramatic increase in the number of patients identified with a potential diagnosis of MCI. 646

A Guide for Introducing Balint Groups Into the Canadian Family Medicine Curriculum

Caitlin Christie, MD, MPH, Toronto, ON; Nena Watson, MD, MA, Toronto, ON; Charlie Guiang, MD, CCFP, Toronto, ON; Holly Knowles, MD, CCFP, Toronto, ON

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Description: Objectives: 1. To highlight the prevalence of burnout and depressive symptoms among resident physicians 2. To discuss an evidencedbased intervention that has been demonstrated to decrease burnout and depressive symptoms among resident physicians 3. To describe how Balint groups could be effectively integrated into Canadian family medicine residency programs Context: Resident physicians experience a considerable amount of stress dealing with the somatic and psychological concerns of their patients. Long work hours and the substantial body of medical knowledge that must be mastered during the residency program often compound this stress. Consequently, burnout and depressive symptoms are a prevalent phenomenon among residents. Much research has been conducted on interventions designed to decrease burnout and depression amongst resident physicians. In particular, Balint group participation is a well-studied intervention in the medical education literature. Objective: To describe how Balint groups could be effectively integrated into Canadian family medicine residency programs. Design: Literature review. Target Population: Canadian Family Medicine residency training programs. Intervention: N/A. Outcome Measures: N/A. Findings: Balint groups are a formal component of many American family medicine residency-training programs.

However, few (if any) Canadian family medicine residency programs provide their residents with an opportunity to participate in a Balint group. Similar to our American colleagues, Balint groups could effectively be integrated into the current behavioural medicine curriculums of Canadian family medicine training programs. Important considerations when implementing a Balint group as part of a residency curriculum are: appropriate facilitation, mandatory versus voluntary participation, timing of the sessions, confidentiality and appropriate evaluation of the impact of the group on participants. Conclusions: Previous research has demonstrated that by providing members with an opportunity to meaningfully discuss patient encounters, residents who participate in Balint groups develop an improvement in their self-confidence as a physician, feel more in control of their clinical environments, report less burnout and depressive symptoms and are more satisfied with their medical careers. Given the documented positive outcomes associated with Balint group participation, implementation of Balint group into family medicine residency programs may be a useful tool to help address burnout and depression among resident physicians.

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Paging Primary Care: On-call service in a family health team

Charlene Antony, MD, Hamilton, ON; Joan Li, MD, Hamilton, ON; Jennifer Brooks, MD, Hamilton, ON; Harkiran Mallhi, MD, Hamilton, ON

Description: Paging Primary Care: On Call Service in a FHT Charlene Antony, Joan Li, Jennifer Brooks, Harkiran Mallhi Context: Family Health Teams (FHT) provide access to a comprehensive team based approach to primary family healthcare services. The McMaster FHT offers evening and weekend on-call access that function as a point of care and triage service. Objective: To assess the effectiveness of phone management by examining the CTAS scores of patients sent to the emergency department (ED) and to improve the efficiency of the on call service by identifying issues that could be addressed at a clinic visit. Design: This is an observational, cross-sectional, retrospective study, which will examine all calls made to the on-call service for a 7-month period between November 2013 and May 2014. Target Population: Our inclusive sample is composed of all after-hours calls within a FHT comprised of 33,241 patients. Instrument: The data was collected from answering service logs and through OSCAR, the FHT’s electronic medical record (EMR). Outcome Measures: 1. The percentage of patients that utilizes the on-call service and their reasons for calling. 2. Disposition of the patients and accuracy of the phone diagnosis compared to the ED. Results: In a 7-month period, the on-call service logged 1210 calls. This correlates to only 3.6% of the FHT who are users of the service. Of patients who accessed the service, 17.3% required further assessment in clinic, and 14.5% were sent to the ED. Of the patients sent to the ED, 83.1% were appropriate consults with an average CTAS score of 3 ±0.7. The three most common reasons for calls were 1) infections of the respiratory, urinary, or gastrointestinal (GI) tracts (33.6%), 2) practice management issues (e.g. prescriptions and results) (13.4%), and 3) other GI concerns (e.g. abdominal pain and nausea) (8.6%). Conclusions: The majority of calls were handled solely by phone; however, the significant frequency of practice management calls identifies the need for reviewing the means that patients can access this information.

Furthermore, a greater emphasis on raising awareness of the on-call service should be undertaken. In addition, clinicians appear to appropriately send patients to the ED. 648

Exploring Gender-Specific Screening Practices in Family Medicine in Alberta: A pilot study Todd Hill, PhD, Calgary, AB; Peter Eppinga, Calgary, AB; Cathlin Mutch

Description: Increasingly, we are aware that physician gender influences medical screening practices, and that gender-concordance is a relevant factor in preventive screening. Previous work has been done analyzing rates of screening practices through retrospective analysis of databases, physician surveys about personal practice, and patient surveys about physician recommended screening practices. None of these studies have been able to control for neither patient variables nor physician-patient relationship variables. The present study was performed using a survey of Family Medicine residents and practitioners, asking how they would apply screening tests to specific clinical vignettes. This method was utilized in order to better control for patient variables and physician-patient relationship variables, and to allow analysis of self-reported screening recommendations based more on physician characteristics (i.e. gender and experience). Clinical vignettes were developed to assess cancer screening recommendations. They included two (2) gender-specific and one (1) gender non-specific scenarios. We chose cancer screening due to the availability of both gender specific and gender-neutral cancer screening guidelines with similar characteristics. In total we had 90 participants (41 Family Medicine preceptors, 49 Family Medicine residents) from the University of Calgary. The only significant gender-concordant result was that females (both residents and preceptors) were significantly more likely to endorse mammography screens for the 55 year old healthy female patient. All other results reflected gender and experience differences for the gender non-specific screening vignette, and therefore did not reflect gender-concordance. Male practitioners endorsed FIT testing significantly more than did females for a 48 year old healthy patient, whether the patient was gender unspecified, male or female. Residents were significantly more likely to suggest FIT screening for the healthy 48 year old male, and for the healthy gender unspecified patient. Male practitioners were significantly more likely to endorse FIT screening for a 48 year old patient (male or female) either if the patient had a family history in an 80 year old primary relative, or if the patient had previous screening. With the exception of mammography, our results did not support the original hypothesis of gender concordance, but did uncover some interesting and significant differences in screening recommendations.

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Student Posters / Affiches des étudiants NOVEMBER 12 NOVEMBRE 623

Improving Patient Education in Family Practice: How and what you share with patients Cathy MacLean, MD, CCFP, FCFP, St. John’s, NL; Jessica Dwyer, St. John’s, NL

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Adherence to Metabolic Monitoring Guidelines for Atypical Antipsychotics in Family Medicine

THURSDAY • JEUDI

Description: This poster deliberately uses plain language to demonstrate writing that does not preclude patients who read below a sixth grade level from reading its content. The purpose of this project was to become more aware of how family doctors educate their patients and to suggest simple ways in which to improve these methods of sharing knowledge. The first part of this project critically appraised the patient education materials (PEMs) currently on display in local family practices. This insight led to the development of the D-OC-E-R-E guidelines. This original method, as its acronym outlines, can be used to assess the quality of PEMs based on their display, obtainability, consistency, effectiveness, readability, and explanation. The focus of this project then shifted towards determining how PEMs in the waiting room could be used to enhance a patient’s educational experience. Further insight was gained through the development of a needs assessment survey distributed to the four teaching clinics in St. John’s, NL. The survey asked patients to report their highest school level obtained, comfort level in reading the survey, health concerns of interest, and medium through which they would prefer to receive such additional information. The results of this survey serve as a reminder to consider readability of PEMs, as patients are diverse in educational attainment. As for receiving additional materials, patients reported an interest in information on eating healthy, weight loss, physical activity, and healthy aging. Since physician-patient interactions often include education about acute health concerns and chronic disease processes, PEMs may be purposefully geared towards preventative health. Lastly, the survey revealed a trend towards electronic options to self-educate. With a shift to more patient-centered care and continuous advances in technology, patients now express a preference for researching their own health information. To ensure patients receive credible information, reliable Internet sources can be offered in addition to traditional written PEMs. From this project, it is evident that physicians may integrate patient education materials into their practices effectively when mindful of health literacy and patient preferences. The next part of this project will involve applying and disseminating this knowledge to encourage positive change.

Timothy Rudd, MA, MD candidate, Kitchener, ON; Thomas Muir, MD; Andrew Costa, PhD

Description: Context Atypical antipsychotics (AAPs) are increasingly being prescribed by primary care providers as first-line treatment for psychiatric disorders, as well as for off-label use. However, they have a known side effect profile that includes hyperglycemia, hyperlipidemia and weight gain. Adherence to metabolic monitoring guidelines is important in family practices to ensure that AAPs are not adding to the already heavy burden of metabolic disease. Objective This research project was designed to determine baseline rates of metabolic monitoring for patients taking AAP’s. Design and Participants Eight family physicians in an academic centre consented to retrospective chart review with a study period from July 19 2013 to July 19th 2014. The study population included all patients of the eight participating physicians who were taking an AAP during the study period, providing a total sample size of 62 patients. Abstracted Data Abstracted data included patient age and gender, name of AAP taken, and the number of times each metabolic monitoring parameter was recorded while the patient was taking an AAP. Outcome Measures The metabolic monitoring parameters used as outcome measures (BMI, waist circumference, fasting glucose, fasting lipids, blood pressure) were chosen based on guidelines provided by the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Results Adherence to the metabolic monitoring guidelines for these patients over the course of the 12 month study period was 4.5% for BMI, 1.6% for waist circumference, 2.2% for fasting glucose, 8.3% for fasting lipids and 40.6% for blood pressure. Adherence at baseline was 3.2% for BMI, 1.6% for waist circumference, 0% for fasting glucose, 3.2% for fasting lipids and 32.3% for blood pressure.

Conclusions The data shows that adherence to metabolic monitoring guidelines for AAPs is extremely poor. It demonstrates that the issue deserves further study to determine whether the findings are representative of other academic and non-academic centres. If they are, it is likely that there are many patients suffering from metabolic side effects of AAPs currently going undetected. Improving adherence to metabolic monitoring guidelines could significantly reduce this burden of illness, improving patient health outcomes and decreasing demands on the healthcare system.

625 Language Barriers in Family Practice Offices in BC: A pilot study of using telephone-based medical interpreters

Sarah Grant, BS, New Westminister, BC; Christina Liciu, MD, CCFP; Adaora Ezeaputa, MD

Description: Context: Having limited English proficiency (LEP) results in health disparities which can be effectively addressed using medical interpreters. However, in British Columbia there is no system for using and funding interpreters in community-based family physicians’ offices. Objective: To determine the feasibility of using free telephone based professional medical interpreters through the pre-existing Provincial Language Services (PLS), in family physicians offices in four cities in British Columbia. Design: Program implementation and evaluation. Participants: All 240 family physicians who are members of the Fraser Northwest Division of Family Practice (FNDFP) were eligible for inclusion in the study. Intervention: All family physicians in the Fraser Northwest Division of Family Practice were given information on and provided access to PLS. Through PLS family physicians had access to free telephone

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE based professional medical interpreters in over 150 languages. Participants were advised that they may be contacted after using the service to provide feedback on their experience. Outcome Measures: Quantitative outcomes included frequency of use, length of call, and languages used. Qualitative outcomes assessed were benefits and barriers of using telephone interpretation. Findings: After one year, there were 65 calls by 10 doctors in 14 different languages. Each doctor used the service from 1 to 12 times. The average length of call was 14 minutes. Five of the physicians who had used the interpretation services and five physicians who had not yet used the service were interviewed. Despite reported challenges to using telephone interpretation there was an overall positive view about having the service available. Conclusions: This pilot study demonstrates the feasibility of using telephone interpreters in family doctors offices. Overall attitudes towards future use of telephone interpreters were positive. Ongoing evaluation is needed to increase uptake of the service and improve efficiency.

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Hesitancy of Transitioning Care Of Cancer Survivors From the Oncologist to the Family Physician Trevor Morey, Whitby, ON; Geoff Liu, MD, Toronto, ON; Lindsay Herzog, Toronto, ON

Description: Objective: The number of cancer survivors is increasing in Canada. However, there is currently no standardized system for transitioning from oncologist to family physician follow-up care. Few studies have investigated cancer survivors’ preferences, and the reasons behind them.

Participants: were cancer survivors (older than 18, had an established diagnosis of a malignant tumor with curative treatment intent, able to communicate in English, with no significant cognitive impairment) at Princess Margaret Cancer Centre who were candidates for transition back to their family doctor. Instrument: Through a cross-sectional survey, we created a hypothetical alternative model of follow-up care to assess hesitation towards transitioning directly back to family physicians. This alternative was a transitional specialist clinic, where patients would receive care from a specialist nurse or physician to assist in the transition to the family physician. Hesitancy is then measured as preferring this hypothetical model to direct transitioning. Outcomes: We assessed the importance of 11 difference physician characteristics factors and their influence on a cancer patient’s preference to receive follow-up care directly from their family physician. Results: Of 230 cancer survivors, 55% were males; with a mean age of 56 years. The diagnoses included 20% breast, 20% colorectal, 14% testicular 12% lung and 33% with other cancers. While 23% preferred to transition directly from oncologist to family doctor, 77% preferred the hypothetical transitional specialist clinic. Patients were more likely to prefer direct transition from oncologist to family doctor if they valued the trust (OR=2.27 [95% CI:1.6-3.1]; p<0.001), and comfort (OR: 1.89 [1.41-2.56]; p<0.001) of seeing their family doctor. In addition, preference for the alternative model of transition was associated with prioritization of their doctor’s skill at diagnosing new cancers (OR: 0.52 [0.320.82]; p=0.005), and their doctor’s knowledge of long-term effects of medications (OR: 0.58 [0.38-0.90]; p=0.01) as factors in their choice.

Conclusions: Up to three quarters of cancer survivors are variably hesitant to receive cancer follow-up care from their family physicians.

Overcoming such hesitancy through patient and physician education may improve the cancer survivor’s transition from oncologist to family physician.

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Identifying Barriers to Physician Provided Smoking Cessation Interventions in the Community Navjot Rai, MSc, RRT, MD candidate, Etobicoke, ON; John Abrahamson, MD, FRCP, Toronto, ON

Description: Background: Smoking is the leading cause of preventable death in Canada with more than 37,000 Canadians dying prematurely from tobacco use each year. Physician advice to quit smoking is a known effective component to smoking cessation interventions. Toronto East General Hospital (TEGH) is a funded demonstration site for hospital-initiated smoking cessation interventions that has actively collected smoking profiles on patients that has revealed a lack of community physician counseling and provision of other smoking cessation interventions to patients. To better assess and bridge this healthcare gap, this study examined the health services determinant of health through assessment of barriers and needs of primary care practitioners within the TEGH community in the provision of smoking cessation interventions. Methods: A mixed-methods structured survey was administered to family physicians within the TEGH catchment area to assess the identifiable barriers to providing smoking cessation interventions (primary research question) and identifiable needs to address these barriers (secondary research question). Findings: Preliminary data analysis (N=86) reveals a combination of physician and patient factors cited as common barriers to the provision of smoking cessation interventions including patient motivation, time constraints, cost of interventions, lack of patient compliance and lack of community resources. Further, results have indicated a need for improved access to counseling, reduced cost of interventions and improved physician training. Study Implications: Family physicians have identified a need for further training and supports in the provision of smoking cessation interventions to their patients. By providing targeted resources, the needs of community physicians can be met and can better the health services provided to help achieve better health outcomes. be able to apply these principles in a way that is concrete and succinct. This will save time, and increase the likelihood of patient compliance to exercise recommendations and ultimately positively influence health and longevity.

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Needs Assessment: The utility of prenatal patient education resources within the SMH AFHT Samantha Dunnigan, Toronto, ON; Karen Swirsky, MD, CCFP, Toronto, ON

Description: Context: Prenatal care reduces perinatal morbidity and mortality, and supports women’s medical, social and psychological needs. Pregnant women and unborn children, especially from at-risk, low socioeconomic or non-Western backgrounds, are likely to utilize prenatal care and experience improved health outcomes with prenatal education tailored specifically to their unique healthcare needs. Objective: This study was designed to investigate the utility of the prenatal patient education resources within the St. Michael’s Hospital Academic Family Health Team (SMH AFHT), which serves the inner city population in Toronto, Canada. The ultimate goal was to understand care providers’ perspectives on strategies for enhancing prenatal patient education resources within this setting to better meet patients’ unique needs. Design: This needs assessment study involved mixed methods divided into three phases: 1) Environmental Scan, 2) Survey of Care Providers, and 3) Production of Recommendations. Participants: Staff physicians, nurse practitioners and residents within the SMH AFHT. Instrument: The Environmental Scan of the SMH AFHT involved observing clinic, reviewing the website, performing a document analysis of prenatal patient education materials on Practice Solutions Suite EMR, and meeting with members of the interprofessional team. This process informed the design of the Survey of Care Providers, a four page online survey with questions on current prenatal education practices and future directions.

Results and Findings: Of the 110 care providers (68 Staff MD/NP and 42 Residents) in the study population, 27 completed the survey (21 Staff MD/NP and 6 Residents), providing a response rate of 25%. From the environmental scan and survey results, six recommendations have fmf.cfpc.ca

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been identified: 1) standardization for sites and visit schedule, 2) identifying specific measurable clinical outcomes, 3) engaging and educating nurses, 4) developing resources, 5) making resources publicly available, and 6) continuing this work as a service learning project. Conclusions: This study has led to an enriched understanding of care providers’ perspectives on specific strategies for improving prenatal patient education within the SMH AFHT. By creating a working group to implement these recommendations, we hope to improve prenatal patient education resources within this setting to better meet patient’s unique needs.

630 The Impact of Multi-thematic Longitudinal Curriculum in Family Medicine on Career Choices in Undergraduate Medical Students

Sreyoshi Alam, Riyadh, Saudi Arabia; Fariha Eshrat, Riyadh, Saudi Arabia; Syeda Mina, Riyadh, Saudi Arabia; Baraa Alghalyini, MD, CCFP,MHSC, Riyadh, Saudi Arabia

THURSDAY • JEUDI

Description: Background To explore the impact of the undergraduate family medicine curriculum that influence the career choice of medical students in this field. We also aim to assess whether any factors in the course have an impact on their interest, which can be reinforced to enhance student interest in family medicine. Summary of work A cross-sectional study, using an anonymous, selfadministered online questionnaire, was conducted. Sample included 4th year undergraduate male and female medical students since they were the only batch with equal gender representation, to have completed the family medicine course. Summary of results Overall response rate was 72% (n=105/144).Study respondents were 48.6% males and 51.4% females. Majority of them did not consider family medicine as a career choice before (75.2%) or after (74.3%) completing the course. Assessment of the factors within the course showed that most students considered it to be well-structured, and relevant. Majority understood the relevance of the course at undergraduate level and its relevance to clinical practice.Students agreed/strongly agreed that introduction of family medicine rotations would significantly influence them. A significant majority disagreed that the course positively influenced them.

Furthermore, 56.2% of the students did not find the course instructors to be a motivating factor to pursue a career in family medicine.

Conclusions In general, most of the participants considered family medicine as an important aspect of the undergraduate medical curriculum. They believe the course illustrated its relevance to clinical practice and delineated the roles and responsibilities of family medicine physicians. However, overall the course failed to stimulate any further learning in the students and had no positive influence on their perceptions towards family medicine as a career choice. Take-home message There is a scope for modification of the course to increase student interest in the field of Family Medicine, and thus encourage more students to pursue a career in Family Medicine.

Posters / Affiches NOVEMBER 12 NOVEMBRE 610

Family Medicine--Based Latent TB Screening for Government-Assisted Refugees in Ottawa: Does it work?

Françoise Guigné, MA, MD, Ottawa, ON

Description: Introduction: Canadian Guidelines for Immigrant health note the risk of active Tuberculosis amongst refugees is two-fold above the immigrant population in the first year of arrival. Studies state anywhere from 64-67% of reported TB cases in Canada are amongst foreign-born individuals. Effective screening and treatment of Latent Tuberculosis infection (LTBI) amongst refugees is thus imperative but Canadian studies are limited and are based on Montreal data on refugee claimants and immigrants. This retrospective quality improvement project sought to assess how effectively Government-Assisted Refugees (GARs) are being screened and treated for LTBI by the family medicine clinic based Ottawa Newcomer Clinic’s (ONC) LTBI screening program. Based on the Ottawa Newcomer Clinic results this study considers whether LTBI screening programs can be effectively designed and operated out of a family medicine setting. Methods: The “New Booking Notification” sheets listing all GARs arriving between January 1st 2012 and December 31st 2012 was used to identify the number of GARs in the study. GARs were searched in the ONC electronic medical record to identify active charts, documentation of two-step TST results and referrals to the ONC Latent TB Infection Clinic (LTBIC). LTBIC referral charts were screened for LTBI treatment plan and associated side effects. Results: Of 409 GARs identified in the study period, 305 (74.57%) had active charts, 240 of 305 (78.69%) patients completed TST, 64 of 257 (24.90%) completed TSTs were positive and 68 patients were referred to the LTBIC. Of 42 referrals that were followed at the LTBIC, 33 started isoniazid (INH). Of 33 patients, 20 (60.61%) completed nine months of INH. INH discontinuations were primarily from hepatotoxicity and gastrointestinal side effects.

Conclusion: High levels of TST completion, and LTBI preventative treatment were observed suggesting that the ONC program is comparable to the Montreal programs and that with the right volume of refugees and centralized set-up family medicine clinic based screening programs can be effective LTBI screening settings for GARs.

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE 611 The Effect of a Structured Versus Non-structured Homebound Seniors Program on Resident Attitudes Toward House Calls

Rahul Jain, MD, CCFP, MScCH(c), Toronto, ON; Jocelyn Charles, MD, MScCH, CCFP; Debbie Elman, MD, CCFP, FCFP, Toronto, ON; Jennifer Kong, MD, CCFP, Toronto, ON; Annie Hadi, MD, Toronto, ON

Description: Context: As the number of Canadians aged 65 years and older continues to rise, more attention has been given to home-based healthcare.

Homebound seniors have higher rates of diseases, chronic medication use, emergency department visits, hospitalizations, and challenges in accessing care. Despite this growing concern, the number of physicians participating in house calls is declining. Family Medicine residents have generally perceived lack of training as a significant factor limiting their likelihood of pursuing house calls in the future. Many academic centres have looked into instituting a structured homebound seniors program as part of residency training to improve resident knowledge, skills, attitudes, and confidence in performing house calls. Objective: To determine the effect of a structured versus non-structured homebound seniors program on resident attitudes towards house calls Design: Survey research Participants: Family Medicine residents (PGY1 and PGY2) from all 15 teaching sites at the University of Toronto (sample size 94 residents). Intervention: A survey was distributed to Family Medicine residents at the University of Toronto. Outcome Measures: Sites having either a structured or non-structured homebound seniors program implemented in the residency curriculum were compared to assess if there is a difference in resident perception of house calls.

A needs assessment of resident perspective on improving the house call curriculum was also performed. Findings: The study demonstrated with strong statistical significance that structured programs compared to non-structured programs increase resident exposure, positive attitudes, confidence and plans of pursuing house calls in their future practice. Similarly, a strong correlation of increasing exposure to house calls was associated with higher resident satisfaction. The needs assessment demonstrated that training on billing, procedures, having increased supervision, and greater exposure to house calls would improve their experience during residency. Conclusions: There are positive implications of this study for the healthcare system, medical education system, practitioners, patients and families in improving and sustaining care for homebound seniors which can be implemented at a national level.

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Atelier de formation professorale sur la supervision clinique hospitalière en médecine familiale Sarah Numainville, MD, CCMF, Saint-augustin-de-desmaures, QC; Johanne Théorêt MD, CCMF, FCMF, MA; Bernard Boudreau MD, PhD;

Description: Contexte : Le Collège des médecins de famille du Canada (CMFC) recommande que les résidents en médecine familiale dispensent des soins cliniques en milieu hospitalier supervisés par des médecins de famille. Cette attente du CMFC nécessite une formation du corps professoral à ce sujet. Objectifs : Identifier les besoins de formation professorale concernant la supervision en milieu hospitalier; Implanter un atelier de formation professorale selon les besoins identifiés; Évaluer un atelier de formation professorale. Plan : Développement, implantation et évaluation d’un atelier de formation professorale. Participants : Les médecins de famille supervisant les résidents en milieu hospitalier lors de leur stage en médecine familiale, affiliés aux douze Unités de Médecine Familiale (UMF) de l’Université Laval. 14 médecins de famille ont participé à l’atelier de formation professorale pilote. Intervention : Une étude de besoins à devis descriptif mixte a été réalisée auprès de la population cible. L’atelier de formation professorale a été développé selon le modèle de Kern. L’évaluation de l’atelier a été réalisée selon le modèle de Kirkpatrick. Mesure des résultats : L’évaluation de l’atelier a été réalisée sous forme de questionnaire électronique avant, immédiatement après et six semaines après l’atelier. Le questionnaire a évalué l’appréciation, les apprentissages effectués et l’impact de la formation sur la supervision en milieu hospitalier. Résultats : L’étude de besoins a démontré les sujets prioritaires pour l’atelier. L’atelier a été apprécié par les participants, qui ont eu une amélioration globale de leurs connaissances. Les attitudes, en termes de degré de confort et de réalisme, se sont améliorées, à l’exception du réalisme ressenti concernant l’intégration des moments d’enseignement lors d’une erreur médicale et l’évitement de toute poursuite médico-légale impliquant un résident. Ils ont augmenté la fréquence d’application des activités enseignées, à l’exception de l’enseignement au résident lors d’une erreur médicale. Conclusion : L’atelier de formation professorale a répondu aux besoins de formation des médecins de famille superviseurs en milieu hospitalier. L’enseignement au résident lors d’une erreur médicale est jugé difficile. Une formation professorale plus approfondie à ce sujet serait recommandée, surtout avec la venue des CanMEDS 2015 et l’intégration de la sécurité au patient.

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The Transition Into Academia of New Family Medicine Faculty

Michelle Levy, MD, CCFP, FCFP, London, ON; Judith Brown, PhD, London, ON; Sudha Koppula, MD, MClSc, CCFP, Edmonton, AB

Description: Capacity building in academic Family Medicine needs not only the continued infusion of talented new faculty, but also the successful transition and growth of such individuals within the academic setting. There is a paucity of literature on the process of becoming an academic faculty in Canadian Family Medicine Departments and the impact this may have on recruitment and retention. Objective: To examine the experience of new, full-time academic faculty in Canadian Departments of Family Medicine as they transitioned into academia. Design: Qualitative study using a phenomenological approach. Setting: Eight Canadian Departments of Family Medicine. Participants: English speaking academic family physicians, on faculty at a Canadian Department of Family Medicine for more than one and less than five years.

Purposeful sampling was done to represent geographical and gender differences. Thirteen interviews were performed before saturation was achieved. Instrument: Data was collected using semi-structured in depth interviews. Interviews were audiotaped and transcribed verbatim.

The transcriptions were reviewed by all investigators independently and then analyzed together in an iterative and interpretive manner.

Outcome Measure: Themes emerging from the qualitative analysis. Findings: Key themes identified included orientation, transition to academia, and seeking a balance. Orientation was often lacking or suboptimal, leaving participants discontented and left to navigate the transition process alone. Challenges in transitioning to academia crossed over multiple roles including clinician, teacher, researcher and administrator. Uncertainty of role categories and time allotted to each led to participants facing the third theme, seeking a balance, between their professional roles and personal needs. Conclusions: The transition to an academic faculty position in family medicine is substantial, often with minimal preparation. The presence of an orientation appears to be one of the factors needed to ameliorate the sense of being overwhelmed. Senior leadership needs to guide new faculty in the preparation and adaptation to their various role categories.

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Un nouveau diplôme de santé de la famille et santé communautaire en 2015 au Maroc

Josette Castel, MD, MSc, CCMF, FCMFC, Quebec, QC; Safwane Mouwafaq , MD, Enseignant Chercheur à l’Ecole Nationale de Santé Publique du Maroc (ENSP); Chakib Nejjari, MD Professeur en Médecine, Directeur de l’Ecole Nationale de Santé Publique du Maroc (ENSP)

615 Development and Evaluation of a Program to Introduce Medical Humanities to Teachers of Clinical Medicine

Leonard Bloom, MDCM, CCFP, FCFP, Ottawa, ON; Lynn Bloom, MSW, RSW; Doug Archibald, PhD, CCFP; Ottawa, ON; Catherine Robertson, MD, FRCPC; Robert Parson, MEd; Mary Arseneau, PhD; Jean Roy, MD, FCMF

Description: Introduction: Within the Faculty of Medicine, University of Ottawa, as well as elsewhere, the medical humanities have been identified as a focus of curriculum enrichment. While an increasing number of University of Ottawa medical faculty have introduced humanities into their teaching, and a compilation of creative works has been developed, there are no specific faculty training workshops demonstrating how these works can be used. The overall goal of this workshop series is to increase the knowledge base and skills of our clinical educators in the medical humanities. It is anticipated that the provision of a theoretical overview of four defined areas – Narrative Medicine, History of Medicine, Visual Thinking Strategies, and Theatre-Based Methods – combined with reflective exercises and teaching tools within these areas, will assist faculty in the subsequent introduction of humanities-based material in small group teaching. Methods: A multiple methods approach is being used to evaluate the impact of the four training modules. Informed consent to participate in the study is requested at the beginning of each workshop. Participants complete brief surveys about their experiences with the relevant facet of medical humanities immediately before and after each workshop, and again 3-6 months later. Semi-structured interviews are being conducted to determine the impact of the workshop on the teaching practices of participants. This method will allow for the triangulation of aggregate data from the session evaluation surveys with the qualitative information from semi-structured interviews. Results: Results from three of the four workshops will be presented. Findings to date include a positive response to a workshop on Narrative Medicine, History of Medicine, and Visual Thinking Strategies, and newly inspired teaching goals among workshop participants. Participants have indicated greater awareness of humanities-based resources after attending sessions. More concrete examples have been requested on how to incorporate humanities based resources into teaching. More time is needed to determine impact: not all tutors have had a chance to teach small group sessions Conclusion: Feedback to date shows a receptiveness to medical humanities among educators and a growing interest in incorporating narrative techniques, a historical context and arts-based methods into medical teaching.

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THURSDAY • JEUDI

Description: Introduction : Au Maroc le Ministère de la Santé fait le constat de l’inadéquation de la formation du médecin généraliste (MG) par rapport aux exigences de la première ligne, de la nécessité de redynamiser les soins de santé primaires et de revaloriser la médecine générale. Le Ministère s’est engagé à offrir une formation orientée vers la prise en charge de la santé de la famille et de la communauté. La discipline de la médecine familiale n’existe pas au Maroc. Objectifs : Développer un diplôme de santé de la famille et santé communautaire pour la mise à niveau des MG Participants : MG dans les établissements de soins de santé de base (ESSB) Méthodes : Suite à une étude de faisabilité, création d’un programme de formation en partenariat entre l’ENSP et la direction des hôpitaux et des services ambulatoires du Ministère. Conception de contenus par un coordonnateur pédagogique de l’ENSP et les enseignants de l’école, soutenu par un appui technique d’une consultante du Québec. Résultats : Formation de 2 ans adaptée à la réalité de la pratique des MG dans les ESSB selon les caractéristiques de la médecine générale/médecine de famille de la WONCA. Le programme se base sur un référentiel de compétences en 4 domaines : prise en charge intégrée et globale du patient, prévention et promotion de la santé et développement communautaire, gestion de la circonscription sanitaire, encadrement et développement professionnel. 10 modules avec enseignement en classe et stages permettent l’intégration du nouveau rôle du MG en plus de séminaires de mises à niveau clinique selon les besoins d’acquisition de compétences exprimés par les MG. Discussion : La pertinence de tenir cette formation dans une école de santé publique est à souligner. Conclusion : Ce programme innovateur est une initiative d’envergure pour développer la médecine de famille au Maroc et améliorer la prestation des soins de santé primaires.

Patients Living With Disabilities: The need for quality primary care

Aisha Lofters, MD, PhD, CCFP, Toronto, ON; Sara Guilcher; James Milligan; Joseph Lee; Niraj Maulkhan

Description: Objective: To compare potential risk factors for lower quality primary care, potential markers of unmet needs in primary care, and willingness to link medical records with provincial databases for research among primary care patients with versus without disabilities. Design: A waiting room survey using a convenience sample. Setting: A Family Health Team in Kitchener-Waterloo, Ontario. Participants: 40 patients seen at a designated Mobility Clinic and 80 patients from the general patient population. Main outcome measures: Socioeconomic status and social capital, number of self-reported emergency room visits and hospitalizations in the preceding year, and willingness of the patients in the two groups to link their medical records and primary data with provincial administrative databases for future research studies. Results: Patients from the Mobility Clinic were more than twice as likely to be on benefits or social assistance (75.0% vs. 32.1%, p<0.001), were twice as likely to report an annual household income of less than $40,000 (58.6% vs. 29.2%, p=0.006), and were more likely to report their health status as fair or poor (42.5% vs. 16.3%, p=0.002).

Half of Mobility Clinic patients had visited the emergency room at least once in the preceding year, compared to 29.7% in the general patient population (p=0.027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (p=0.004). Conclusion: In this study, patients with disabilities were at a social disadvantage to their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE should continue to explore this patient population and to investigate if an inter-professional primary health care team approach focussed on patients with disabilities can help to increase quality of care.

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Performance of Family Medicine Residents on the CFPC Certification Exam

Shirley Schipper, MD, CCFP, Edmonton, AB; Shelley Ross, PhD, Edmonton, AB; Judith Belle-Brown, PhD, London, ON; Carlos Brailovsky, MD, Laval, QC

Description: BACKGROUND: All Family Medicine residents in Canada, including International Medical Graduates (IMGs), write the national certification exam in the last 6 months of training. Nationally, in both the written and oral parts of the exam, IMGs perform less well than Canadian trained Medical Graduates (CMGs). Candidates who fail the certification exam are not able to practice in some regions in Canada, and only with a restricted license. To rewrite the exam is both stressful and expensive. OBJECTIVE: To determine the reasons why candidates fail the certification exam, particularly the simulated office oral (SOO) portion of the exam. METHODS: SOO exam papers for those candidates that failed were reviewed for scoring and examiner comments. Themes of comments were analyzed and categorized. RESULTS: We outline the 2013 and 2014 Spring and Fall exam results, themes in examiner comments on failed papers and explore patterns seen in candidates who failed the SOO (simulated office oral) portion of the exam. DISCUSSION: Providing insight into performance for both CMGs and IMGs may help residency programs in exam preparation activities, knowing which areas to focus in remediation training, and tailoring programs to increase exposure in specific areas. This may improve the pass rate for all residents in the future.

618 Knowledge and Interest in the Postcoital Intrauterine Device Among Women Seeking Emergency Contraception

Sheila Dunn, MD, MSc, CCFP (EM), FCFP, Toronto, ON; Dilzayn Panjwani, MSc, Toronto, ON; Ciara Pendrith, MSc, Toronto, ON; Anna Ly, Toronto, ON; Christine P. Edwards, Toronto, ON

Description: Context: There are two methods of emergency contraception (EC) which can be used to reduce the risk of pregnancy after unprotected intercourse: hormonal EC (levonorgestrel pill) and insertion of a copper intrauterine device. The IUD offers much higher effectiveness and also provides highly effective ongoing contraception, but many women are unaware of its use for emergency contraception. Objective: This study sought to determine knowledge and interest in the postcoital IUD among women seeking emergency contraception. Design: Paperbased survey. Participants: convenience sample of women aged 16-50 years, able to read English and requesting emergency contraception at 2 sexual health clinics in Toronto from January 2013-July 2014. Study Instrument: A 39-question survey was adapted for a Canadian context from 2 US questionnaires used to determine knowledge and interest postcoital IUDs. Questions asked about demography, sexual health history, and respondents’ knowledge about IUDs and their interest in using the postcoital IUD. Outcome measures: Knowledge about the IUD and interest in using it for EC. Results: One hundred and twenty-four women completed questionnaires. Mean age was 25.6 years (SD 6.6). Most respondents were Canadian-born (69%), single (80%), students (40%) or in full-time employment (38%), and had post-secondary diploma or degree (73%). The most common reasons for needing EC were condom failure (37%) and failure to use birth control (28%).

Seventy-six percent of respondents had previously use EC and 36% had had a prior abortion. Most women (77%) had heard of the IUD but only 21% knew it could be used for emergency contraception. Sixty-six percent of women indicated they did not want an IUD, but 18% were interested, 6% booked to have one inserted that day and 9% were unsure. The most common reasons for not wanting an IUD were, not knowing enough (24%), needing time to think (16%) and not having the time for insertion (15%). Conclusions: Most women seeking EC were unfamiliar with the postcoital IUD, but a sizeable minority were interested in using it. This study emphasizes the need for promoting knowledge about all options for EC. 619

Management of Osteoporosis Through an Evidence-Based Pilot Program

Anne Souter, MD, CCFP, FCFP, London, ON; Emily Stoll, London, ON; Andrew Dawson, London, ON; Cathy Faulds, MD, CCFP, FCFP, London, ON; Ciara Walsh, BA, London, ON

Description: Context: Although osteoporosis has significant system and patient impact, little has been done to develop effective programs for management at the primary care level. Using evidence-based guidelines, physicians from the Primary Care London FHO have developed a pilot program to better manage osteoporosis through improved patient outcomes. Objective: The aim was to improve outcomes for patients with osteoporosis, while ensuring that our care was patient-centered, evidence-based, and applicable in a primary care setting. Design: We have created a before-and-after study that examines how our intervention has impacted our outcomes. Participants: From an initial target screening population of 2468, 451 patients have been diagnosed with osteoporosis and managed and treated through our program.

Intervention: We designed our program using evidence-based guidelines to determine appropriate methods of treatment, timelines for screening and management, and outcome parameters. We built EMR templates for clinical visits and tracking of outcome measures.

Standardized BMD orders, blood work requisitions, and the FRAX calculator were embedded into our EMR to ensure ease of ordering and to assist in risk categorization. Currently, low-risk patients are sent a standardized letter through the EMR containing their diagnosis and healthy lifestyle information. Moderate and high-risk patients are booked for an appointment using the Osteoporosis Treatment Plan template.

Data is recorded on a spreadsheet containing the process, outcome, and balance measures deemed appropriate by local specialists and our Osteoporosis Pilot Group. Outcome Measures: Patients that were diagnosed with moderate to severe osteoporosis were tracked for: frequency of visits for osteoporosis, frequency of BMD, prior and recent T-scores, ordering of thoracolumbar x-ray, FRAX score, self-management, fragility fractures, falls, and pharmacotherapy. Results: Baseline data has been collected and monthly review of our measures has begun.

We have seen an increase in visits dedicated solely to osteoporosis. Additionally, the percentage of the eligible patient population sent for diagnostic BMD scans has improved from 30% to over 50%. Conclusions: Our results indicate a stronger focus on preventative management of osteoporosis by the physicians within the Primary Care London FHO.

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621 Selection for Family Medicine Residency Training: Is it time to sharpen our tools? A study of the consistency of selection processes between programs in Canada

Keith Wycliffe-Jones, MBChB, FRCGP, CCFP, Calgary, AB; Shirley Schipper, MD, CCFP, Edmonton, AB; Maureen Topps, MB, ChB, CCFP, FCFP, PBDM, Calgary, AB; Kent Hecker, PhD, Calgary, AB; Jeanine Robinson, BA, MPA; Tasnima Abeda, Calgary, AB

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A Canadian Needs Assessment of Health Care Professionals in Binge Eating Disorder Management Richard Ward, MD, CCFP, FCFP, Canmore, AB; Michael Vallis, PhD, R.Psych, Halifax, NS; Hany Bissada, MD, FRCPC, Ottawa, ON; Josée Guérin, DtP, BSc, Montreal, QC

Description: Objective: To identify the learning needs of Canadian health care professionals (HCPs) in binge eating disorder (BED) management.

Methods: Between December 2014 and January 2015, over 15,000 Canadian HCPs specialized in eating disorders (EDs) (dietitians, family physicians, psychiatrists, psychologists, combined) were invited to complete an online questionnaire to assess their level of understanding and comfort in the management of BED. A total of 365 HCPs seeing ED patients in their practice completed the questionnaire. Results: Dietitians, family physicians, psychiatrists and psychologists comprised 38%, 31%, 17% and 9% of respondents, respectively. The survey revealed that 90% of respondents never received formal training on BED. Only 30% of respondents describe BED as a distinct diagnostic entity, while 60% consider BED as part of a spectrum of EDs. While 41% recognize the lack of compensatory behaviour as the main differentiator of BED, 13% relate it to poor impulse control. Responses showed high levels of ambivalence with respect to prevalence, onset and diagnosis. Only 24% attested to making a positive diagnosis of BED. Only 39% of respondents consider the psychopathology underlying the condition as the main treatment goal for patients. Several inconsistencies in the level of understanding and comfort in managing BED between specialties were apparent. Lack of training, communication and psychiatric co-morbidity management were identified as common challenges. Conclusions: This assessment suggests significant knowledge gaps in the optimal management of BED patients. There is a need to improve the expertise amongst various HCP specialties involved in BED patient care.

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THURSDAY • JEUDI

Description: Context This study examines the consistency of the ranking of Canadian Medical Graduates (CMG’s) who applied to Canadian Family Medicine Residency Programs between 2007 and 2013. Previous UK research revealed a very low level of consistency in the ranking of medical student applicants to General Practice training. Canadian FM Programs are more heterogeneous than in the UK but the expected outcome of training is still a Family Physician who can practice anywhere in Canada and many of the listed selection criteria by programs are the same. Objective This study questions whether there is a high level of consistency in the ranking of the same applicants by Family Medicine Residency Programs, particularly those seeking similar attributes. Methods Anonymised ranking data from all 17 FM Residency Programs for the first iteration of the Canadian Resident Marching Service process for CMG’s who applied to more than one Family Medicine Residency Program or site between 2007 and 2013 was used for this study. Ranking data of applicants were analyzed for inter-school (within student) agreement using hierarchical linear models. The within- and between- student covariance parameters were also used to calculate the intra-class correlation (ICC). Overall inter-school analysis was completed for years 2007 to 2013. In addition, sub-set analysis on groups of programs and sites identified as similar (e.g. rural) was also carried out for the 2013 match cycle. Results Overall, there is weak consistency in the ranking of the same students amongst Canadian FM Residency Programs. (ICC =0.365). More detailed analysis shows there is slightly less variability in the ranking of students who apply to programs identified as being “rural”(ICC 0.362-0.552) but still very low consistency of ranking of students by programs/sites identified as being more urban-based (ICC=0.271). Conclusions The current selection processes for Canadian Family Medicine Residency Programs are inconsistent. This could have implications for selection for Family Medicine Residency training in the future.

FIFE Yourself: Two minutes of mindfulness a day toward physician resilience Douglas Cave, MSW, RSW, PhD, RPsych, MA, AMP, Vancouver, BC

Description: Physicians who learn the Patient-Centred Care Model learn to FIFE their patients. They learn to assess the patients’ feelings, ideas, function and expectation regarding the patients’ chief complaint. Physicians are well trained in how to care for others. They are less well trained in how to care for themselves. Medical education engenders competitiveness, perfectionism and impression management. One way impression management presents is that many physicians struggle to seek personal help when it is needed.

Unfortunately, burnout and other critical effects are the result. Mindfulness-based techniques are beneficial and mitigating tools to manage some of the ill effects or working in medicine. Self FIFE is an innovated technique whereby physicians use a memory cue each day as a reminder to ask themselves a set of 4 reflective questions regarding their own feelings, ideas, function and expectation.

This research is about testing the efficacy of the 2-minute-per-day self-FIFE tool. Being prompted by a self-selected memory cue, participants of this study were invited to ask themselves 4 self-reflective questions. The study occurs over an 8-week period which is the standard length of time given to assess other mindfulness programs. Participants were invited to complete a battery of measures including the Beck Depression Inventory II, Beck Hopelessness Scale, Maslach Burnout Inventory, State-Trait Anxiety Inventory, Life Satisfaction Scale and some demographic questions as baseline measures. After an 8-week period the participants will be invited to complete the test battery again as a post-test measure of change. Cohen’s d will be used to measure any effect of the 8-week program. Results are pending because data is being collected at this time. Since the study is being done with people who are motivated to participate in research; it is anticipated they will already score in the more positive range of the scales. As a result, the effect of the self-FIFE tool will likely be measured as small. If self-FIFE does have an effect, then it may be taught with greater

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE confidence to help maintain physician resilience.

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Village Health Empowerment Programme: Engagement and evaluation

Vivian Ramsden, RN, PhD, Saskatoon, SK; Jessica Winter, Regina, SK ;Erin Russell, Saskatoon, SK; S. Kanchana, RN, PhD, Chennai, India; K.R. Rajanarayaan, MD, Chennai, India; Kim Sanderson, PhD, Saskatoon, SK; Vivian Ramsden, RN, PhD, Saskatoon, SK

Description: Context: To engage and empower rural villages served by Omayal Achi Community Health Center (OACHC), Arakampakkam, India.

Objective: To evaluate the non-communicable diseases screening programme (e.g. high blood pressure, diabetes) being undertaken by Village Health Workers at a Kiosk. Design: The overall design of this study was informed by the integration of community-based participatory research, transformative action research and program evaluation. Participants: Village Health Workers. Instrument: Checklist co-created

by Registered Nurses, researchers and undergraduate medical students (India & Canada). Outcome Measures: The Checklist included all procedures and measurements expected to have been performed at the Kiosks where the Health Empowerment Programme had been implemented. Results: Generally, height, weight, and waist circumference were correctly measured. The significance of values such as BMI, blood pressure and blood glucose were not well understood by the Village Health Workers. Areas for improvement included: proper blood pressure measurement; recording of measurements; and, explanations of procedures and measurements. Participants indicated that the Kiosk was convenient; however, there was a lack of awareness about its presence within the villages. In addition, participants expressed a desire for medicines to be made available at the Kiosk because it was closer to their homes. Conclusions: The Kiosk was well received by those villages that participated. Improving adherence to the procedures and measurements listed on the Checklist may result in enhanced prevention and management of chronic disease within villages served by OACHC. 633

Interprofessional Collaboration in Family Medicine Simulation: Experience with a pilot mini-course

NatalieKennie-Kaulbach, BScPharm, PharmD, Halifax, NS; Joanna Zed, MD; Karen McNeil, MD; J Szabo; K Hayward

Description: Context: A focus of primary health care reform has been a shift to teams of providers delivering comprehensive services. Currently, there are limited opportunities for students to participate in interprofessional education (IPE) experiences in the primary health care setting. Objective: This project describes the delivery and student evaluation of a pilot mini-course for interprofessional collaboration in Family Medicine.

Design: Description of course developed and course evaluation Participants: Undergraduate students from medicine, nursing, pharmacy and social work Intervention: A six hour, three week mini-course was developed. Over a three week period students were introduced to key concepts (role definition, interprofessional communication, collaboration, primary health care) through a combination of online audio presentations, readings, and discussion groups and utilization of high contextual fidelity simulation. Working together student teams interviewed a simulated patient, played by an actor, and developed a collaborative care plan. The session concluded with a debriefing on the interprofessional experience and opportunities for collaboration in primary health care. Outcomes Measures: Students were e-mailed a feedback survey at the end of the course to evaluate student satisfaction and experiences. Results: A total of 18 students making up 5 teams of undergraduate students from medicine, nursing, pharmacy and social work completed the course. Seventeen (17) feedback surveys were completed. Respondents indicated a better understanding of their professional role and how they might work with other providers, as well as more confidence in and a stronger commitment to practicing interprofessionally. Respondents indicated they most liked the case, simulated patient interaction and team work. Suggestions made to improve the program will be considered for the next offering. Conclusions: This IPE course was well received by students and was successful in fostering competencies and commitment to interprofessional collaboration.

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A Checkup on Clinical Tools: Needs assessment of primary care providers in Ontario

Katie Hunter, MSc, Toronto, ON; Amanda van Hal, BSc, Toronto, ON; Apurva Shirodkar, PhD, Toronto, ON; Lena Salach, MA, Toronto, ON

Description: Context: The Centre for Effective Practice (CEP) is collaborating with the Ontario College of Family Physicians (OCFP) and Nurse Practitioners’ Association of Ontario (NPAO) to develop and disseminate health information and clinical tools for primary care providers (PCPs; family physicians and primary health care nurse practitioners). As a first step in this initiative, a needs assessment was conducted with PCPs in Ontario to determine their information needs and communication preferences. Objectives: To better understand the perspective of PCPs on: 1. Key elements of clinical tools; 2. Clinical topic prioritization from a pre-determined list; and 3. How to best communicate with and engage PCPs. Methods: An online survey was developed in order to gain input from PCPs across the province in a cost effective and timely manner. The survey was developed, pilot tested and distributed to family physicians (via OCFP) and primary health care nurse practitioners (via NPAO). Over 10 weeks, 810 responses were received. Only complete responses (n=640) were included in the final analysis. Results: Respondents were asked to rate the importance of a number of factors that would determine whether they would utilize a clinical tool. The three factors most frequently identified by respondents as being important to them were: relevance to their practice (97%), topic area (97%),

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and having the time available to utilize the material (94%). PCPs responding to the online survey indicated that they preferred clinical tools to be communicated via email (84%), from a recognized expert (63%) or posted on a website (57%) and survey respondents most often indicated that they would like to receive clinical tools at least once a month (29%). Additional results, including preferred topic area(s), will be presented and discussed. Conclusion: The findings will be used to inform activities for the Knowledge Translation in Primary Care Initiative. Results will help to ensure the development and communication of clinical tools for PCPs is reflective of their needs and preferences.

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Social Accountability and Rural Generalist Training at Memorial University

James Rourke, MD, CCFP (EM), MCISc, FCFP, FRRMS, FCAHS, LLD, St John’s, NL; Kristin Harris Walsh, PhD, St John’s, NL; Danielle O’Keefe, MD, CCFP, MSc, St John’s, NL; Scott Moffatt, MD, CCFP, FCFP, St John’s, NL; Mohamed Ravalia, MD CCFP, FCFP, Twillingate, NL; Wanda Parsons, MD, FCFP, St John’s, NL; Norah Duggan, MD, CCFP, St John’s, NL; Katherine Stringer, MB ChB, CCFP, St John’s, NL; Janelle Hippe, MA, St John’s, NL

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THURSDAY • JEUDI

Description: Context: Memorial’s Faculty of Medicine’s social accountability mandate focuses on educating physicians for rural generalist practice in a province with large geographic space and widely disbursed population. It supports many “pathways to rural generalist practice” and provides training for the specialized skills and contextual learning required. Objective: To determine Memorial’s success in recruiting rural students, providing rural educational opportunities, and producing rural doctors. Design: Data was drawn from the Learners and Locations database at Memorial University and includes admissions, One45, Canadian Medical Directory, and Statistics Canada population data. SPSS was used to analyze statistics and ArcGIS was used to produce maps. Participants: Participants are MUNMED grads 2011-2012 (N=120). Intervention: Memorial’s MD Education program. Outcome Measures: This study measured the educational pathways for MUNMED 2011-2012 graduates: their backgrounds, where they completed their education, their residency locations, and their current practice location. Results: Of 120 students who graduated from 2011 to 2012, 31.7% had rural backgrounds. MUNMED students graduating in 2011 and 2012 spent 18% of all placement weeks in rural areas: 89% in first year and 95% in third year (Family Medicine). For 25 MUNMED grads 2011-2012 who did FM residencies at MUN, 34% of placement weeks were spent in small rural communities or small rural cities. Of 30 MUNMED grads 2011-2012 practicing Family Medicine in Canada as of January 2015, 13 (43%) were practicing in small rural communities or small rural cities. Of 22 MUNMED grads 20112012 practicing Family Medicine in NL as of January 2015, 11 or 50% were practicing in small rural communities or small rural cities. Conclusions: There is excellent external evidence that Memorial’s pathways to rural generalist practice approach is effective and successful. In 2010 and 2013, Memorial received the Keith award from the SRPC for having the highest percentage of Family Medicine training program graduates (52% and 44% respectively) working in rural practice 10 years after graduation. The results of this study indicate continuing success.

Involving Family Physicians in Early Identification of Eating Disorders: A national survey Ahmed Boachie, MB, ChB, DCH, MRCPsych, FRCPC, FAED, Newmarket, ON; Pierre-Paul Tellier, MD, CCFP, Montreal, QC; Patricia Mousmanis, MD, CCFP, Richmond Hill, ON; Karin Jasper, PhD, RP, Newmarket, ON; Debra Katzman, MD, FRCPC, FAED, Toronto, ON

Description: Context: Children and adolescents with early onset eating disorders, who receive treatment within two years show better outcomes, particularly with family-based treatment. Early identification and treatment may also lower health care costs. Family physicians are in a unique position to identify eating disorders early. The revisions of the DSM 5 endeavour to address the issue. Objective: To understand factors that will assist family physicians in the early identification and management of eating disorders in children and adolescents, specifically to learn family physicians’ current awareness of early warning signs of eating disorders and the extent to which they manage these disorders in their own practices. Design: The study is a survey with multiple-choice questions, requiring 5 minutes of physicians’ time. It has been implemented as a pilot and will be implemented on a national level. Participants: In the pilot, family physicians who referred patients to an eating disorder program were called and asked if they would consider completing the questionnaire. It was faxed to those who agreed. In the National study, all family physicians registered with the College of Family Physicians of Canada will be invited to complete an online version. Results: Pilot study physicians assessed patients between the ages of 12 and 18 over the preceding year. Most common diagnoses were bulimia, anorexia, and avoidant/restrictive food intake disorder (ARFID). Physicians were effective in recognizing classic eating disorder symptoms but most missed the non-specific symptoms characteristic of early onset. All physicians endorsed as either likely or very likely that they would use a screening tool, immediate referral to a specialist service, and a practice-based learning program (PBLP) for eating disorders, if these were available. A PBLP was endorsed as increasing the likelihood that family physicians who do not currently manage these patients in their practices would do so. Conclusions: The pilot study suggests that without further training for family physicians, we will continue to struggle with early identification. A PBLP, an initial screening tool, and immediate referral to a specialist service would be valued by family physicians.

The National study will provide greater understanding of these important issues.

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1-800-Imaging Pilot: Building partnerships between primary care and medical imaging

Karen Weiser, MBA, Toronto, ON; Lilly Whitham, Toronto, ON; Pauline Pariser, MASc, MD, CCFP, FCFP, Toronto, ON; Heidi Roberts, MD, FRCPC, Toronto, ON; Catherine Wang, Toronto, ON; Paul Cornacchione, Toronto, ON; Corwin Burton, Toronto, ON; Christina Ciapanna, Toronto, ON

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | THURSDAY 12 JEUDI | PROGRAMME SCIENTIFIQUE Description: The 1-800-Imaging pilot is a virtual hub designed and implemented by The Joint Department of Medical Imaging in partnership with Women’s College Hospital Institute for Health System Solutions and Virtual Care (WHIV) and Seamless Care Optimizing the Patient Experience (SCOPE). The pilot was designed according to the Institute for Healthcare Improvement principles of the “Triple Aim” to improve patient/provider experience of care, better population health, and lower per-capita costs of care. Primary Objective: To improve integration between community primary care providers (PCPs) and a tertiary sub-specialized medical imaging department to facilitate urgent imaging (when appropriate) and provide navigational and consultative services. The goals of the pilot were to reduce inappropriate imaging orders and emergency department visits, and to improve patient and provider experience. Participants: Sixty Toronto physicians registered in the SCOPE Program and who are not members of a Family Health Team. Intervention: Calls to the virtual hub were answered and coordinated by a clerical staff in real-time and directed to a radiologist as required. The following services were offered: 1. Appropriateness Consult 2.

Radiology Consult 3. Urgent Imaging 4. Urgent Reporting 5. General Informational Requests Findings: From May 2014 to March 2015, the following results were found: • 227 calls received - 103 requests for urgent imaging - 40 appropriateness consults - 10 radiology consultations - 7 requests for expedited reports - 67 requests for information • 36 unique callers (60% of pilot audience) • 22 users accessed the call centre multiple times (61% of callers) Participating physicians reported that 40 emergency department visits were avoided by accessing the call centre and 40 appropriateness consultations supported callers in ordering imaging that was most appropriate for their patients. Of 42 post-call surveys, 100% were satisfied with the service and 100% stated that they would recommend the call centre to their colleagues. Conclusions: • A call centre is an effective model for PCPs to ask questions and navigate complex medical imaging centres • PCPs value conversations with radiologists to gain clinical insights and validation • Sustainability and scalability require dedicated operational resources and a roster of on-call radiologists 639

Use of a Quality Improvement Strategy to Increase Flu Immunization Rates Among Racialized Groups Ankur Jain, MD, Toronto, ON; Abel Gebreyesus, MHI, Toronto, ON; Liben Gebremikael, MA, Toronto, ON; Nancy Akor, RN, Toronto, ON; Onye Nnorom, MD, CCFP, MPH, FRCPC, Toronto, ON;

Description: Context: Previous studies have shown influenza vaccination rates remain low across Canada (30-40%), but rates also vary by subpopulation.

TAIBU Community Health Centre has a mandate to provide primary healthcare services to the Black Community and also serves the largely immigrant population in Malvern. Despite efforts to provide regular flu clinics, vaccine rates at TAIBU were less than 10% for three years.

In 2013, TAIBU conducted a qualitative assessment, documenting reasons for flu vaccine refusal in patient charts and analyzing the most common responses, which included: (1) lack of familiarity with the influenza vaccine; (2) mistrust of the vaccine; (3) and the statement “I never get the flu.” Based on these results TAIBU’s Prevention & Screening Taskforce identified key interventions to address immunization barriers. Objective: To evaluate the impact of targeted initiatives in increasing influenza vaccination rates at TAIBU CHC. Design: Quality Improvement Planning & Evaluation Population: Patients at TAIBU CHC Intervention: A multi-pronged approach was used to address barriers to influenza immunization. (1) Reminder calls were made to the clients of TAIBU CHC about the upcoming flu clinics, prioritizing highrisk patients. (2) Flu vaccine posters specifically targeting the Black community were also placed at noticeable locations with details about upcoming flu clinics. (3) Healthcare providers were reminded regularly to offer the influenza vaccine to clients. (4) Flu fact sheets from Toronto Public Health were distributed to providers guide conversations with patients and nursing staff provided counselling on the flu vaccine to patients. Results: 300 calls were made to clients (majority were high-risk) between October 1 and November 30, 2014. Overall, influenza vaccinations increased from 9% in the 2013-14 flu season to 21.78% in the 2014-15 season. High-risk influenza vaccinations were up to 45.06%. Conclusions: Although patient misconceptions about the influenza vaccine and underestimation of susceptibility to influenza have been barriers at TAIBU CHC, the use of a multifaceted strategy to respond to patient concerns resulted in a 12% increase in influenza immunization rates.

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The Virtual Ward: How to keep patients at home? ... (safe) L’Unité Virtuelle : Garder les patients à la maison en sécurité

Bernardo Kremer, Montreal, QC; Isabelle Vedel; Mina Ladores; Hanane Saad; Genevieve Arsenault Lapierre; Justin; Gagnon; Vinita D’Souza; Genevieve Gray

Description: Introduction: Aging population with complex care needs (chronic medical, psycho-social) is increasing the demands on the current healthcare system. Patients are vulnerable during transitions in care especially at post-hospitalization discharge. Weaknesses in transitional care contribute to high rates of readmission, longer stays and even death. The Virtual Ward (VW) at the Herzl Family Practice Centre provides multidisciplinary care for elderly patients identified as high risk for future hospitalization. Our main research objective is to determine and evaluate the current performance and the potential for transferability of this family medicine based virtual ward. Method This is an effectiveness-implementation trial with a multiphase sequential design. Throughout the phases of the study, a Participatory Approach is used beginning with a panel of experts who describe the intervention, identify key components and develop indicators for the evaluation of the impact and transferability of the VW. This includes a quasi-experimental study with a historical control group followed by a qualitative descriptive study with healthcare professionals who will evaluate the implementation dynamics and transferability of the VW. Preliminary Results • Assembled a team including researchers, clinicians, students, medical residents and patient representatives. (Core group meets weekly, extended partners meet bi-annually). • Refined current VW clinical practices by documenting VW procedures, identifying key features and creating standardized templates i.e. medication reconciliation, telephone calls and social evaluation. • Received detailed feedback from 3 physicians and 2 patient representatives on VW practices. • Continually compiling a list of transferability ideas to be shared with other clinical sites. Conclusion This project is important not only because it assesses a novel family medicine based intervention but it also begins to address the possibility of transferring what is learned at the Herzl Family Practice Centre to other clinical sites. This study is unique because it is led by a family physician and follows a participatory approach where clinical researchers, clinical staff and patient representatives can contribute to its success.

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F111302 A SHARE the Decision in Stroke Prevention in Atrial Fibrillation 06:45–07:45 Anil Gupta, MD, CCFP, FCFP, Etobicoke, ON; Jeff Habert MD, CCFP, FCFP, Thornhill, ON 801AB MTCC Learning Objectives: 1. determine stroke risk stratification for patients according to the CCS 2014 guidelines and identify the benefits and risks of current oral anticoagulants based on recent clinical trials and real-world data 2. assess and understand patient perspectives on treatment options, including concerns, misconceptions, and treatment preference 3. effectively communicate with and engage the patient in the decision-making process to ensure adherence to treatment plan, and include guidance at subsequent visits Description: Patients with atrial fibrillation have a significant increased risk of stroke and have increased post-stroke mortality and morbidity. Oral anticoagulation is a powerful treatment to prevent strokes and the novel oral anticoagulants have proven to be a major therapeutic advancement in the treatment of stroke prevention in atrial fibrillation. As the treatment decision for anticoagulation entails balancing the risk of stroke and the risk of bleeds, it is important for physicians to engage patients in this decision. This evidence-based session will provide family physicians with the opportunity to increase their knowledge and comfort level on treatment options, includes a review of clinical guidelines and real-world data, and provides physicians with a tool to help them effectively SHARE The Decision in Atrial Fibrillation with their patients.

Participants may claim an additional Mainpro-M1 credit for attending this session

F115446 A 06:45–07:45

Current Approach to Obesity Management: A new framework for front-line health providers Sean Wharton, MD, FRCPC, Hamilton, ON 701AB MTCC

Learning Objectives: 1. understand the current principles of obesity management and gain confidence in identifying and addressing barriers 2. know how to conduct a personalized obesity assessment and appropriately match patients to different management strategies 3. be aware of the new treatment options available in Canada

F96068 07:00–08:00

Respiratory Medicine Networking Breakfast: What's new in 2015 and what articles should you know about?

Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON; Suzanne Levitz, MD, CCFP, Montreal, QC; John Li, MD; Chris Fotti, MD; Elaheh Mousa Ahmadi, MD 705 MTCC

friday • vendredi

Description: Obesity is a complex condition driven by several factors. This makes obesity management a complex and sometimes frustrating challenge. As research and clinical experience has shown, the traditional advice to “eat less and move more,” accompanied by meal and exercise plans, falls short of what most patients need. This slide presentation outlines an obesity management road map that goes beyond the traditional paradigm and draws on the latest research into the deep drivers of obesity. The presentation follows the evidence-based “5As of Obesity Management” framework developed by the Canadian Obesity Network. Extensively tested among primary care providers, the 5As framework offers a sensitive and sustainable management strategy that seeks to improve health and well-being, rather than to simply aim for numbers on a scale.

Participants may claim an additional Mainpro-M1 credit for attending this session l

Learning Objectives: 1. highlight new issues in respiratory medicine 2. review the top 5 articles in respiratory medicine from the past year 3. review the relevance of these highlights to clinical practice Description: 2015 has brought us a plethora of new medications for pulmonary fibrosis, respiratory infections, asthma, and COPD. We will also highlight the articles that you should know about from the past year that WILL change your practice. Come and meet other family physicians who have a passion for respiratory medicine; I promise it will be worth getting up early for (and you get breakfast too!).

F99994 07:00–08:00

Networking for Teachers of International Medical Graduates (IMGs) Susan Phillips, MD, CCFP, Kingston, ON; Inge Schabort, MD, CCFP, FCFP, Hamilton, ON 715B MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. review the current pathways from medical school training outside Canada to Certification in Family Practice 2. network with others in the academic community involved in the selection and training of IMGs 3. discuss changes in requirements for application to residency via CaRMs and review recent experiences of family medicine residency programs with the CaRMs IMG process Description: Susan Phillips and Inge Schabort are both academic family physicians in Ontario with years of experience co-ordinating IMG programs and assessing data regarding indicators of IMG success in residency.

F101390 Maternity and Newborn Care Networking Breakfast 07:00–08:00 Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Anne Biringer, MD, CCFP, FCFP, Toronto, ON; Sudha Koppula, MD, CCFP, Edmonton, AB; Rose Anne Goodine, MD, CCFP, Woodstock, ON; Balbina Russillo, MD, CCFP, Montreal, QC; Shanna Fenton, MD, CCFP, FCFP, Saskatoon, SK; Eve-Lynne Kyle, MD, CCFP, Montreal, QC 707 MTCC Learning Objectives: 1. identify current issues in maternity and newborn care for family physicians 2. discuss successes and challenges in maternity care 3. network with colleagues who share similar interests

F102181 07:00–08:00

The Risks of Family Practice: Introduction to the occupational medicine foundations course − Networking breakfast

Joel Andersen, MD, CCFP, Sudbury, ON; R. Douglas Hamm, MD, CCFP, Victoria, BC 709 MTCC

Learning Objectives: 1. understand the methodology of course delivery in a distant learning format 2. demonstrate the applicability of the course content to enhance the physicians' skills in managing day-to-day, common occupational health problems, to the benefit of their patients and their community, and to industry 3. outline details of access to enrolment in the course in different regions of practice in Canada Description: There is a documented lack of undergraduate and postgraduate training in occupational medicine for family physicians. This has impacted on practising family physicians' capability to effectively handle the wide range of occupational medical demands of family practice that present to the physician on a daily basis. This gap in training has been shown to negatively affect the timely and safe return-to-work process required by patients, the community, and industry. An occupational medicine training program has been developed and is currently delivered across Canada by the University of Alberta, Edmonton. This session will inform physicians in detail of the methodology used to deliver this distant learning program to family physicians, with the objective of allowing them to remain in their community while taking the course. The program, on completion, is accredited by the CFPC to provide 109 CPD credits.

F102799 07:00–08:00

Moving Forward as a Community of Practice Engaged in Global Health Katherine Rouleau, MD, CCFP, Toronto, ON 715A MTCC

Learning Objectives: 1. summarize the activities of the Global Health Committee for 2015 2. identify three priority issues around which to engage the CFPC Global Health Community of Practice 3. develop a summary action plan to engage the CFPC Global health Community of Practice Description: In keeping with the nature of the field of global health itself, the CFPC Global Health Community of Practice is highly diverse. This diversity has challenged the ability of the Global Health Committee to engage members more fully. During this session, participants will be asked to identify the three most pressing needs of the community of practice and to propose actions to begin to address them.

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FV300 08:00–09:30

Keynote / plénière Choosing Wisely Canada / Choisir avec soin Canada

Wendy Levinson, MD, Toronto, ON; Lynn Wilson, MD, CCFP, FCFP, Toronto, ON Hall FG MTCC

Learning Objectives: 1. describe the reasons that physicians may order tests that don‘t add value or may harm patients 2. describe the Choosing Wisely Canada campaign and the role of primary care 3. share specific strategies to implement Choosing Wisely in medical education and practice Description: Choosing Wisely Canada (CWC) is a campaign to help physicians and patients discuss tests, treatments, and procedures, and make smart and effective choices to ensure high-quality care. It is modeled after the Choosing Wisely® campaign in the United States, launched by the ABIM (American Board of Internal Medicine) Foundation in April 2012. Choosing Wisely Canada launched in Ontario and has quickly been adopted by all provincial and territorial medical associations. It is now a truly national campaign in Canada and leads the international effort. This campaign has created patient-friendly educational materials and is working with various groups to disseminate these materials widely. CWC is also working with medical schools to introduce new content into the undergraduate, postgraduate, and continuing medical education curricula. Join Dr Levinson and Dr Wilson for this relevant and important keynote presentation.

Objectifs d‘apprentissage : 1. décrire les raisons que les médecins évoquent pour demander des tests qui n‘ajoutent pas de valeur ou qui peuvent causer un préjudice aux patients 2. décrire la campagne Choisir avec soin Canada et le rôle des soins primaires 3. partager des stratégies précises afin de mettre en œuvre Choisir avec soin dans la formation médicale et la pratique

F96062 10:00–10:30

Should Physicians Recommend Electronic Cigarettes to Help Patients Quit Smoking?

Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON; Suzanne Levitz, MD, CCFP, Montreal, QC; John Li, MD 801AB MTCC

Learning Objectives: 1. describe the possible benefits of using electronic cigarettes for smoking cessation 2. describe the concerns regarding the use of electronic cigarettes for smoking cessation 3. personalize the issues for the smoking patient in front of you in the office

friday • vendredi

Description : Choisir avec soin est une campagne visant à aider les médecins et patients à discuter des examens, traitements et interventions dans le but de faire des choix judicieux et efficaces afin d‘assurer des soins de grande qualité. Cette campagne s‘inspire de l‘initiative américaine Choosing Wisely® lancée par la Fondation de l‘American Board of Internal Medicine (ABIM) en avril 2012. Choisir avec soin a d‘abord été lancée en Ontario et a rapidement été adoptée par les associations médicales de l‘ensemble des provinces et territoires. Il s‘agit maintenant d‘une campagne à l‘échelle du pays qui se trouve à l‘avant-plan de l‘effort international. Dans le cadre de la campagne, du matériel de formation convivial a été créé pour les patients, et divers groupes de travail s‘affairent à diffuser ce matériel à grande échelle.

Choisir avec soin travaille également avec les facultés de médecine pour intégrer du nouveau contenu au cursus des programmes d‘études prédoctorales, postdoctorales et de développement professionnel continu. Joignez-vous aux Dres Levinson et Wilson pour cette présentation à la fois pertinente et importante.

Description: One of our priorities in practice is to assist our patients to quit smoking, but are electronic cigarettes the right answer? Do their benefits in assisting smokers to quit outweigh their costs of potential side effects and teratogenicity? Are there societal changes that need to occur to ensure the responsible use of these products? Should they include nicotine? Should they be flavoured? Listen to two colleagues in a friendly but passionate debate over these issues and come away with your own conclusions.

F101444 10:00–10:30

Palliative Sedation: The what, when, and how Irene Ying, MD, MHSc, CCFP, Toronto, ON 701AB MTCC

Learning Objectives: 1. define palliative sedation and distinguish it from physician-assisted dying 2. appreciate clinical scenarios where palliative sedation should be considered 3. develop an approach to palliative sedation and understand why opioids should never be used for palliative sedation

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Description: Even with the wide range of therapies available for symptom management at the end of life, there is a subset of patients for whom adequate symptom control is not achieved with standard interventions and for whom palliative sedation (PS) is a potential treatment option. However, there is often misunderstanding around what PS is and the circumstances under which it is legally and ethically appropriate. This session will clarify what PS is (including distinguishing it from physician-assisted dying), provide an approach to PS, and discuss common pitfalls in its implementation.

F102597 10:00–10:30

What to Expect When She‘s Expecting: Integrating prenatal and preconception health evidence into your practice and community

Sarah Gower, MD, CCFP, Elora, ON 714AB MTCC

Learning Objectives: 1. describe which aspects of preconception and prenatal health give the biggest bang for the buck 2. implement techniques to bring about concrete change in your communities without involving massive funding or hours of free time 3. explain how helping women make healthy changes has long-term effects on their babies, families, and communities—be inspired!

Description: Pregnancy is an ideal time to intervene in unhealthy lifestyles, and to empower women to change themselves and their families.

Pregnant women trust their health care providers and look to us for evidence-based information and guidance. But what do we focus on? How do we make suggestions around weight gain and parenting readiness that are quick and useful and don‘t make patients feel bad about themselves? And how can we intervene even before conception occurs, getting changes underway before it‘s too late? In our rural community, we decided, as prenatal health care providers, that we could do better. We assembled a multidisciplinary group and are developing a “Healthy Pregnancy Strategy.” We aim to develop supportive, non-shaming interventions to educate and support our pregnant women, as well as to start a new community focus on preconception health.

In a short time, we have already been able to educate our local health care providers around healthy prenatal parameters and early identification of women at higher risk, to establish a common set of prenatal resources that every pregnant woman in our region can easily access, to work with our public health unit to trial a preconception screening tool, and to partner with local epidemiology students to answer research questions. This session will outline the most up-to-date evidence around preconception and prenatal health lifestyles, and discuss ways to address these issues quickly and effectively in prenatal appointments. The case study of our “Healthy Pregnancy Strategy” will include pearls on making lasting changes in your community as a physician without a lot of time or funding. We all want to improve the overall health of our communities, and this session will inspire you with the knowledge that targeting preconception and prenatal health is an excellent way to really make a difference.

F96240 10:30–11:00

What Are the Benefits of Group Prenatal Care and How Interested Are Most Women in It? Sarah McDonald, MD, FRCSC, MSc, Hamilton, ON 714AB MTCC

Learning Objectives: 1. assess the extent of maternal and infant benefits of group prenatal care compared to traditional prenatal care 2. describe participants‘ views on group prenatal care, from the perspective of both women and care providers 3. identify the level of interest in group prenatal care among women receiving traditional prenatal care Description: Group prenatal care (GPC) originated in 1994 as an innovative model of prenatal care delivery. In GPC, eight to twelve pregnant women of similar gestational ages meet with a health care provider to receive their prenatal check-up and education in a group setting. GPC offers significant infant and maternal health benefits in comparison to traditional, one-on-one prenatal care. Many women in GPC actively engage in their health care and experience a supportive network with one another in the group visits.

F96962 The ABC's of Exercise Assessment and Prescription for the Prevention and Management of Chronic 10:00–11:00 Disease / L‘ABC de l‘évaluation et de la prescription d‘exercice dans la prévention et la prise en charge des maladies chroniques

Pierre Frémont, MD, PhD, FCFP, Dip Sport Med, Quebec, QC hall f MTCC

Learning Objectives: 1. discuss the scientific basis of the spectacular potential and safety of exercise for the prevention and management of chronic diseases with patients 2. integrate the ”exercise vital sign” as part of the periodic health examination 3. use the exercise referral and prescription tool developed by ”Exercise is Medicine Canada” and the CFPC for exercise assessment and basic prescription fmf.cfpc.ca

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Description: The “Exercise is Medicine Canada” collaborative task force has developed a tool to assist family physicians and health care providers in assessing physical activity participation and providing basic exercise prescription as part of a periodic health examination. This project was supported by the Sports and Exercise Medicine committee of the Section of Communities of Practice in Family Medicine (CPFM).

Objectifs d‘apprentissage : 1. L‘ABC de l‘évaluation et de la prescription d‘exercice dans la prévention et la prise en charge des maladies chroniques 2. intégrer le « signe vital de l‘exercice » dans l‘examen périodique de santé 3. être en mesure d‘utiliser l‘outil de prescription d‘exercice et d‘orientation mis au point par « L‘exercice : un médicament Canada » et le CMFC pour évaluer l‘exercice et en rédiger une ordonnance de base Description : Le groupe de travail « L‘exercice : un médicament Canada » a mis au point un outil visant à aider les médecins de famille et autres professionnels de la santé à évaluer la participation à l‘activité physique et à prescrire l‘exercice de base dans le cadre de l‘examen de santé périodique. Ce projet a bénéficié de l‘appui du Comité de la médecine du sport et de l‘exercice de la Section des Communautés de pratique en médecine familiale.

F101889 10:00–11:00

Work Related Exams and Forms / Examens et formulaires liés au travail Craig Karpilow, MD, CCFP, FCFP, Hamilton, ON 718AB MTCC

Learning Objectives: 1. discover how to manage work-related examinations in a typical family practice so that they do not interfere with other patient care or take disproportionate time, and so that staff can schedule them appropriately 2. determine the appropriate manner to approach work related , disability, and return to work forms and examinations 3. describe time-effective methods of performing a work-related examination or completing disability or return-to-work forms

Objectifs d‘apprentissage : 1. découvrir comment gérer les examens liés au travail dans une pratique familiale typique afin qu’ils n'interfèrent pas avec les soins aux patients ou ne prennent un temps disproportionné, et que le personnel peut les préparer de façon appropriée 2. déterminer la manière appropriée de remplir les formulaires et effectuer les examens liés au travail, à un handicap ou à un retour au travail 3. décrire les méthodes efficaces pour effectuer des examens liés au travail ou remplir des formulaires d’invalidité ou de retour au travail Description : En tant que médecins de famille, on nous demande souvent d’effectuer des examens pour le ministère des Transports et de remplir divers formulaires liés à la capacité de travailler et à l’emploi, y compris les documents d’invalidité et de retour au travail. Ces tâches peuvent prendre beaucoup de temps dans une pratique occupée et ne sont pas très rémunératrices. Elles peuvent également être très importantes afin de déterminer si votre patient peut physiquement effectuer un certain travail de façon sécuritaire. L’impossibilité de faire cette détermination correctement peut avoir des conséquences à long terme pour le patient, et si elle est effectuée incorrectement, elle peut entraîner des conséquences sérieuses pour le médecin. Cette séance précise ces points et présente une méthode complète, simple et efficace à suivre pour permettre au médecin d’effectuer ces examens.

F102078 10:00–11:00

friday • vendredi

Description: As family physicians, we are often asked to perform Ministry of Transport exams and to fill in various other fitness-to-work or employment forms, including return-to-work and disability documents. These tasks can be time-consuming in a busy practice and not significantly remunerative. They can also be very important in determining if your patient can physically and safely perform a certain job. Failure to make this determination properly can have long-lasting consequences for the patient, and if improperly done, have serious ramifications for the physician. This session clarifies these points and presents a comprehensive, simple, and time-effective method for the physician to use in completing these exams.

Iron Deficiency Anemia: Recognition and management in the office and the emergency department Yulia Lin, MD, FRCPC, Toronto, ON; Dominick Shelton, MD, CCFP, FCFP, Toronto, ON hall g MTCC

Learning Objectives: 1. recognize iron deficiency anemia 2. prescribe treatment for iron deficiency anemia 3. manage patients with iron deficiency anemia in the emergency department Description:

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. The prevalence of iron deficiency anemia has been found to be as high as 4 per cent in women, 16 per cent in pregnant women in the third trimester, and 6 per cent in elderly patients. However, IDA is underrecognized and undertreated. In severe cases, patients are often referred to the emergency department for red blood cell transfusion.

The first objective is to learn how to recognize iron deficiency anemia. Anemia is defined as hemoglobin less than 120 g/L in women and less than 130 g/L in men. Iron deficiency is defined as a ferritin level less than 30 ug/L OR less than 100 ug/L with a transferrin saturation less than 20 per cent. A mean cell volume (MCV) less than 80 fL when previously documented as normal can also be an indicator of IDA. Causes of iron deficiency anemia will be reviewed. The second objective is to learn how to prescribe treatment for iron deficiency anemia.

The available oral iron formulations will be discussed, along with their side effects. Indications for intravenous iron and its side effects will also be presented. The final objective will be to learn about a quality improvement project aimed at improving the management of patients with IDA in the emergency department. An algorithm will be presented on how to decide whether or not to transfuse a patient with IDA. The risks of transfusion will also be discussed, including the risks of alloimmunization (formation of red blood cell antibodies), which in women of childbearing age increases the risk of hemolytic disease of the newborn in future pregnancies. A case-based approach will be used to increase interaction with the audience.

F102400 10:00–11:00

Ominous and Awesome: New trends in addiction and its treatment

Meldon Kahan, MD, CCFP, FRCPC, Toronto, ON; Anita Srivastava, MD, CCFP, Toronto, ON

716B MTCC

Learning Objectives: 1. outline a primary care approach to managing cannabis use disorders 2. describe how family physicians can reduce the risk of opioid overdose and addiction through patient selection, dose titration, tapering, and prescribing buprenorphine 3. discuss the role of medications in the treatment of alcohol use disorders Description: This presentation will review three major trends in substance use. 1) Both recreational and medical marijuana strains have become much more potent. Licensed producers are producing strains with THC concentrations of 20 per cent or higher. The acute and chronic harms of marijuana are linked with the THC dose, and include psychosis, addiction, impaired work and school performance, and motor vehicle accidents. Family physicians need a strategy for dealing with requests for medical marijuana. They can help daily cannabis smokers through screening, advice, referral, and medications. 2) Prescribing of potent opioids, such as hydromorphone and fentanyl, has increased since the removal of OxyContin from the Canadian market. Canada is now the highest per capita consumer of opioids in the world, and prescription opioid overdose is now a leading cause of death in young adults in Canada. Family physicians can reduce opioid harms through careful patient selection and dose titration, opioid tapering when indicated, and prescribing buprenorphine/naloxone for opioid addiction. 3) New research suggests anti-craving medications should be prescribed routinely for patients with alcohol use disorders. Medications such as naltrexone, disulfiram, acamprosate, and topiramate can be safely prescribed by family physicians and have been shown to reduce alcohol consumption and alcohol-related morbidity.

F102289 10:00–12:15

Building a Quality Improvement Curriculum Into Your Department of Family Medicine: Exploring effective approaches

Elizabeth Muggah, MD, MPH, CCFP, Ottawa, ON; Phil Ellison, MD, CCFP, FCFP, North York, ON; Karen Hall Barber, MD, CCFP, FCFP, Kingston, ON 705 MTCC Learning Objectives: 1. discover different approaches to integrating quality improvement into family medicine residency programs 2. describe how CANMeds 2015 and the Triple C Competency-based Curriculum methods can support the integration of teaching and evaluating quality improvement skills and knowledge 3. discuss best evidence and experiences with family medicine faculty who are leaders in quality improvement Description: This interactive workshop targets family medicine faculty—including administrators, teachers, and researchers—who are interested in building quality improvement (QI) into their learning environments. QI is an essential part of the effort to close the gap between what we know, what we can learn from our clinical environment, and what we do in our clinical practice to improve. The integration of QI into academic family medicine has emerged in Canada and beyond as an important objective. Doing so requires teaching, modeling, and applying QI skills and theory in a curriculum, and faculty and professional development in the teaching environment. This workshop will be an opportunity to explore an emerging area in family medicine and will result in the sharing of best practices from QI leaders in family medicine from across the country. The workshop will be facilitated by faculty from Queen‘s, University of Toronto, and Ottawa who are leaders in QI in their departments.

F102747 10:00–11:00

Post-Traumatic Stress Disorder: A primer for primary care physicians Alexandra Heber, MD, FRCPC, CCPE, Ottawa, ON; Catherine Classen, PhD, Toronto, ON 501 MTCC

Learning Objectives: 1. recognize the signs and symptoms of posttraumatic stress disorder, and describe the mental, physical, and behavioral problems often comorbid with it 2. explain the rationale and principles of trauma-informed care, and strategies for its delivery 3. propose appropriate pharmacological and psychotherapeutic treatment for posttraumatic stress disorder fmf.cfpc.ca

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Description: In his groundbreaking 1978 research on the prevalence of mental disorders in the US population, Darrel Regier discovered that only one-fifth of those affected by mental illness were seen by specialty mental health providers, while three-fifths were treated by general practitioners. He therefore designated primary care as the "de facto ... mental health services system." Today, primary care practitioners continue to treat the majority of those with mental health problems. This session‘s presenters, both experts in the treatment of posttraumatic stress disorder (PTSD), developed this course for family physicians who care for patients with PTSD. The authors designed the course around two cases that would typically present to a family doctor‘s office: a young woman who is having physical complaints and then discloses a history of childhood sexual abuse, and a military veteran who presents with complaints of poor sleep.The cases illustrate best practices, including making the diagnosis; principles of trauma-informed care; risk factors for PTSD; common comorbidities; and evidence-based pharmacologic and psychotherapeutic treatment. Video clips illustrating principles of PTSD treatment will be shown and discussed. Testimonials (live and videotaped) of people with PTSD, describing their history, symptoms, and experiences with their family physicians, will augment the presentation. Audience participation will be encouraged.

F102790 Advancing Global Family Medicine Through the Besrour Centre: Updates and inputs 10:00–11:00 Katherine Rouleau, MDCM, CCFP, MHSc, Toronto, ON; François Couturier, MD, FCMF, MSc, DTM&H, Sherbrooke, QC; Ryan McKee, MD, CCFP, Kitchener, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe the vision and activities of the Besrour Centre 2. discuss some of the achievements and challenges of the Besrour collaboration 3. propose ways to further pursue the overall goals of the Besrour Centre Description: In 2015, after a three-year consultation process, the College of Family Physicians of Canada established the Besrour Centre, a hub of international collaboration to advance family medicine globally. The Centre brings together all Canadian departments of family medicine, collaborators from 18 countries, and key stakeholders such as the World Bank and WONCA (World Organization of Family Doctors). Through case presentations, structured activities, and interactive discussions, this workshop will deepen participants‘ knowledge of the Centre and invite perspectives on how to further enrich the work of this innovative collaboration.

Experiencing Touch in Family Medicine: Transforming the ordinary Martina Kelly, MBBCh, MA, MICGP, FCRCP, CCFP, Calgary, AB; Lara Nixon, MD, CCFP, FCFP, Calgary, AB 711 MTCC

Learning Objectives: 1. reflect on your experiences of touch as a family doctor 2. experience touch from a new perspective by joining in interactive exercises 3. re-evaluate the role of touch in clinical practice Description: Touch is part of the everyday practice of a doctor: shaking a patient‘s hand, the intimacy of physical examination, performing procedures. It is, however, something we take for granted. Touch is rarely the subject of specific inquiry in medicine and our understanding of touch as a communication process and form of knowledge is rudimentary. How we touch and interact with patients is influenced by our personal experience, culture, family life, education, and the varying contexts in which we practice. Increasingly we are becoming a "no touch society" and concern has been expressed about the concept of "touch hunger" within North America.

The aim of this workshop is to pause, to invest our senses in the experience of touch. We will explore touch as a concept and experience. Touch can be a form of care and connection. It is also described as an issue of risk. We aim to open the "black box," have some fun, and provoke discussion among family doctors. Starting with small group discussion, participants will reflect on the role of touch in health care, stimulated by a poetry reading. Then, adopting a phenomenological perspective, participants will focus on the tactile/haptic experiences of a doctor‘s day-to-day activities by means of "hands-on" activities. We will "make the familiar strange" and use contrasting embodied senses (dance, taste) to facilitate articulating a descriptive account of our touch experiences.

Discussing the relevance of these exercises to clinical practice, our personal ideas, concerns, and expectations will follow.

Implications for future work, research, and education will conclude the workshop.

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F102879 10:00–11:00

F102883 Dealing With Conflict as a Medical Leader 10:00–12:15 Difat Jakubovics, MD, CCFP, FCFP, Toronto, ON; Paul Philbrook, MD, CCFP, FCFP, Mississauga, ON; Pauline Pariser, MD, CCFP, FCFP, Toronto, ON 707 MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. discuss the elements of effective meetings, the chair‘s role, and challenges and conflict styles that can be encountered when working with others 2. develop and integrate into practice leadership skills in managing conflict and conducting effective meetings Description: In 2009, as part of its strategic plan, the Department of Family and Community Medicine at the University of Toronto decided to foster leadership development among the faculty. Among other strategies, this workshop on conflict management was developed. This interactive workshop will provide a background on conflict styles and how to conduct effective meetings. Through cases and active participation, we will explore dealing with conflict, specifically in the setting of conducting a meeting. Assessing conflict styles and how this relates to the management of conflict will be addressed as well. The themes inherent in this workshop include the critical role of an effective chair; self-awareness of one‘s personal leadership and conflict management style; elements to consider in planning, conducting, catalyzing, and following up on meetings; and addressing challenging conflicts, such as managing a disruptive physician. By combining didactic presentation and experiential learning, the workshop will cover basic principles on conflict management and running effective meetings and will enable participants to examine and integrate these principles into their approach.

F106732 SOR/SOT Symposium – Evidence to practice by: What do we need and what are we getting?

10:00–12:15 Michael Allan, MD, CCFP, FCFP, Edmonton, AB; Michael Kolber, MSc, MD, CCFP, FCFP, Edmonton, AB; Tina Korownyk, MD, CCFP, Edmonton, AB 716A MTCC Learning Objectives: 1. recognize robust information worthy of guiding patient care 2. recognize and avoid pitfalls inherent in commonly used resources 3. discuss short- and long-term strategies for managing your information needs Description: Whether trying to stay up-to-date on the treatment of common problems or looking for information on less common problems at the point of care, family physicians will spend their entire career looking for new information to guide the treatment of their patients. What constitutes useful and reliable information? How useful and reliable are some of the more common sources of information that are available to us?

FV108670 10:00–11:00

Mainpro+ … A New Look, With New Ways to Learn (3) Mainpro+ … Un nouveau look; de nouvelles façons d‘apprendre (3)

Eric Wong, MD, CCFP – Regional Educator, Ontario Region / Éducateur régional, région de l‘Ontario, London, ON; Scott MacDonald, MD, CCFP (EM), FCFP – Regional Educator, Atlantic Region / Éducateur régional, région de l‘Atlantique, Bedford, NS 803A MTCC Join us for an informative session on Mainpro+ and the new, practice-centred ways to earn CPD credits for activities you do on a daily basis.

Also, hear the latest updates on fellowship, accreditation, and CACs. The CFPC is committed to providing quality CPD to meet your changing interests and learning needs. Participants may claim an additional Mainpro-M1 credit for this session.

Soyez des nôtres pour une séance d‘information sur Mainpro+ et sur les nouvelles façons d‘obtenir des crédits de DPC pour des activités que vous effectuez au quotidien. De plus, vous pourrez vous renseigner sur les nouveautés concernant le titre de Fellow, l‘agrément et les CCA. Le CMFC s‘est engagé à fournir des programmes de DPC de qualité qui conviennent aux intérêts de ses membres et répondent à leurs besoins en matière d‘apprentissage. Les participants peuvent réclamer un crédit Mainpro-M1 additionnel pour cette séance.

F102424 10:00–12:15

Moving Towards Outcomes-Based Accreditation Systems Nick Busing, MD, CCFP, FCFP, Ottawa, ON; Louise Nasmith MDCM, MEd, FCFP, FRCPSC(Hon), Vancouver, BC 703 MTCC

Learning Objectives: 1. differentiate between process-based accreditation and outcomes-based accreditation and provide two examples of each 2. identify the strengths, limitations, and potential outcome measures of our current accreditation system 3. recognize the need to challenge our current accreditation processes to be more outcomes-focused

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Description: This session on medical education accreditation will be of interest to family medicine program directors, clinical teachers, residents, and clinicians. Canada has internationally recognized accreditation systems for undergraduate medical education, postgraduate medical education, and continuing professional development. However, outcome measures of our system do not directly reflect practice patterns and clinical outcomes, and they need to be socially accountable. The Future of Medical Education in Canada Postgraduate Report recommended alignment of accreditation standards and processes across the continuum of medical education to achieve greater efficiency at less cost. This workshop will present how our current accreditation systems assess competence in relation to measuring outcomes, and address how to move towards the assessment of outcomes rather than of processes primarily.

Participants will engage in a brainstorming session about potential clinical, safety-related, and quality-related outcome measures.

Participants will gain a better understanding of, and be able to influence, outcomes-based accreditation and its potential to improve both the training environment and clinical practice.

F96260 10:00–17:30

Social Networking: the National OSCAR EMR User Group Meeting Colleen Kirkham, MD, CCFP, FCFP, Vancouver, BC; David H. Chan, MD, CCFP, MSc, FCFP, Hamilton, ON; Morgan Price, MD, PhD, CCFP, Victora, BC caledon/oakville – intercontinental hotel

Learning Objectives: 1. interactive working meeting for OSCAR users to learn new features and functions of the EMR 2. potential new users will be introduced to the EMR’s features and the open source community 3. academic multi-province projects will be discussed Description: OSCAR is an ‘open-source’ (free), Canadian browser-based EMR, developed and driven by its users. Users pay no licensing costs and have the freedom to choose who provides support. There are large numbers of users in Ontario, BC, Quebec, PEI and Alberta.

OSCAR is an academic, not-for-profit, national EMR adopted by several University family medicine departments including McMaster, Queen’s, McGill and UBC. It is the only EMR that integrates with a Patient Controlled Health Record (MyOSCAR) and a Knowledge Exchange Social Networking web service (Know2Act).

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Users will learn from other users and the development team about new features and how to maximize their use of OSCAR. They will learn about exciting projects that use OSCAR, MyOSCAR, and Know2Act to deliver innovative care to patients at home utilizing volunteers in their communities. They will learn how to use tools that can improve clinical practice (decision support, research and QI). Non-OSCAR users are welcome to attend to see the EMR and see how the OSCAR community works together.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F96050 11:15–11:45

Asthma-COPD Overlap Syndrome Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON 801AB MTCC

Learning Objectives: 1. define what this new condition means, and what it means to your patient 2. describe the diagnostic approach to a patient with ACOS 3. review the treatment options and follow-up for a patient with ACOS Description: The new international guidelines for both asthma (GINA) and COPD (GOLD) have developed a consensus recommendation on a not uncommon and definitely high-risk condition called asthma-COPD overlap syndrome (ACOS). Distinguishing between asthma vs COPD vs ACOS will be reviewed and it will be clear to you how to approach this newly described but complicated condition in your patients. The first step is assessing lung function, as the patient has to have fixed airway obstruction (FEV1/FVC ratio < 70%) but also have significant bronchodilator reversibility. New and exciting informaton for participants to use and gain comfort in managing respiratory illness.

F96127 11:45–12:15

Preschool Pediatric Asthma: Who needs treatment?

Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON 801AB MTCC

Learning Objectives: 1. identify the different types of "asthma" seen in a preschooler 2. identify which children need longer-term treatment and which will "outgrow" their asthma 3. review treatment approaches for these children Description: Preschool children often wheeze. The diagnostic test for asthma is spirometry, but they are too young to do it. Which wheezing children need inhaled steroids long term and which ones will likely "outgrow" the condition? Can you predict it? We will review the approach to preschool wheezing children.

F96421 11:15–12:15

Medical and Forensic Aspects of Care for the Victim of Acute Sexual Assault Susan McNair, MD, CCFP, FCFP, London, ON; Saadia Hameed, MD, CCFP, London, ON 709 MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. recognize types of genital and non-genital trauma associated with acute sexual assault 2. identify key elements of the forensic assessment of victims of acute sexual assault 3. recall key aspects of the medical management of victims of acute sexual assault Description: This one-hour session will address key issues in the medical examination/assessment and management of victims of acute sexual assault.

The three types of blunt superficial trauma (bruises, abrasions, and lacerations) will be explored in detail. Photos will be used extensively, where appropriate. Important issues in the documentation of such injuries will be detailed. Key elements of the forensic evidence collection will be covered and the forensic evidence collection kit utilized in Ontario will be mentioned. The important aspects of the medical and psychological management of victims of acute sexual assault will be reviewed, including pregnancy prophylaxis and STI prophylaxis, including the appropriate utilization of HIV post-exposure prophylaxis.

F101340 11:15–12:15

Introducing Palliative Care in Chronic Disease Within My Family Practice: Who, why, and how Mirielle Lecours, MD, CCFP, Stratford, PE; Janet Baker, MD, CCFP, Gloucester, ON 802AB MTCC

Learning Objectives: 1. understand and define "palliative care" and the "palliative care approach" and identify patients in your practice who could benefit from a palliative approach earlier in their illness 2. review prognostication using the Gold Standards Framework: General and Disease-Specific Indicators and become familiar with some useful tools (ESAS, PPS, PRFS) 3. explore and define your role and the role of family physicians in providing palliative care in your setting(s) Description: At least 70 per cent of individuals faced with a life-threatening illness will never receive palliative care through a standardized palliative care program. At this moment, less than 30 per cent of Canadians receive this kind of service. In order to be available to every Canadian, it needs to be incorporated into every physician's practice. Family physicians play a critical role in the provision of palliative care to their patients; their knowledge of the family unit is invaluable in the provision of person- and family-centred care. In addition, the provision of continuing, comprehensive care and the ability to collaborate is innate to family physicians and an asset to the provision of palliative care. This interactive workshop will review scenarios faced in everyday clinical practice, use tools to recognize which of these patients could benefit from early palliative care interventions, and use helpful tools, including the ESAS, to implement these approaches. Although not the focus, advanced care planning communication tools will be included in this workshop. fmf.cfpc.ca

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F96975 11:15–11:45

Rehabilitation Innovations for Common Knee Conditions Innovations en réadaptation pour les blessures courantes du genou

Agnes Makowski, FCAMPT, Toronto, ON; Pierre Frémont, MD, CCFP, FCFP, PhD, Dip Sport Med, Quebec, QC hall f MTCC

Learning Objectives: 1. understand the evidence-based rehabilitation approach to common knee injuries 2. be familiar with common muscle imbalances and training myths that affect optimal knee function 3. use injury prevention strategies and exercise prescription tools appropriate for patients of diverse abilities and activity levels Description: This session will allow participants to integrate the rehabilitation perspective in the multidisciplinary approach for the prevention and management of common knee injuries.

Objectifs d‘apprentissage : 1. comprendre les approches factuelles de réadaptation pour les blessures courantes du genou 2. se familiariser avec les déséquilibres musculaires et les mythes courants concernant l‘entraînement qui peuvent perturber le fonctionnement optimal du genou 3. faire appel à des stratégies de prévention des blessures et à des outils de prescription d‘exercice appropriés auprès des patients de diverses habiletés et niveaux d‘activité Description : Cette séance permet aux participants d‘intégrer la perspective de la réadaptation dans une approche multidisciplinaire de prévention et de prise en charge des blessures courantes du genou.

F96979 11:45–12:15

Evaluation and Imaging of Common Knee Injuries in Primary Care / Évaluation et examens d‘imagerie des blessures courantes du genou en soins primaires

Tatiana Jevremovic, MD, CCFP(EM), Dip Sport Med, London, ON; Pierre Frémont, MD, CCFP, FCFP, Quebec, QC Hall f MTCC

Description: This session will allow the family physician to optimize his clinical evaluation skills of knee injuries through an improved understanding of the relation between key elements of the clinical presentation, examination, and investigation of common knee injuries.

Objectifs d‘apprentissage : 1. poser un diagnostic différentiel pertinent basé sur l‘évolution clinique des blessures courantes du genou 2. faire appel aux techniques d‘évaluation pertinentes pour tester les possibilités diagnostiques évoquées par le tableau clinique 3. utiliser l‘imagerie diagnostique de façon rationnelle pour compléter l‘évaluation

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Learning Objectives: 1. make a relevant differential diagnosis based on the clinical history of common knee injury 2. use relevant evaluation techniques to test the diagnostic possibilities suggested by the clinical presentation 3. make rational use of diagnostic imaging to complete the evaluation

Description : Cette séance permet au médecin de famille d‘optimiser ses aptitudes d‘évaluation clinique des blessures du genou par l‘intermédiaire d‘une meilleure compréhension de la relation entre les éléments clés du tableau clinique, l‘examen et l‘investigation des blessures courantes du genou.

F101346 11:15–12:15

Chronic Pain: An approach during pregnancy Lisa Graves, MD, CCFP, FCFP, Ancaster, ON 714AB MTCC

Learning Objectives: 1. distinguish between chronic pain and dependence during pregnancy 2. define appropriate treatment options for chronic pain during pregnancy 3. build a treatment plan for women experiencing chronic pain in pregnancy

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Description: Chronic pain is common in family medicine. Pain and chronic pain can be part of pregnancy. Management of chronic pain in pregnancy requires special considerations including impact of treatment on development and concerns about dependence. An approach to chronic pain during pregnancy will be developed.

F101698 11:15–11:45

Primary Care Approaches to Working With Youth Who Use Alcohol and Substances Sharon Cirone, MD, CCFP(EM), ASAM(Cert), Toronto, ON 716B MTCC

Learning Objectives: 1. identify rapport development as a priority for working with adolescents and young adults in the primary care setting 2. define and describe the components of SBIRT---screening, brief intervention, and referral to treatment---for youth who use alcohol and drugs 3. translate and integrate the tools and skills for SBIRT into their practice Description: Adolescents and young adults have the highest rates of alcohol and drug use in our society and in our primary care practices. Some young people have progressed to alcohol and substance use disorders and some are experiencing considerable risk related to their use. Successful engagement with our young patients is critical to supporting change and healthy behaviours. Universal screening tools can be easily integrated into your practice. Brief interventions to support insight and motivation for change can be implemented into even the busiest of primary care settings. Many family physicians are unfamiliar with their local resources for referral to further treatment for those at higher risk.

Referring physicians and families can become informed and confident in navigating the local addiction treatment systems.

F101702 11:15–12:15

Prescribing Income: A three-step tool to reduce the impact of poverty in primary care Larisa Eibisch, MD, CCFP, MPH, Toronto, ON; Danyaal Raza, MD, CCFP, MPH, Toronto, ON 803B MTCC

Learning Objectives: 1. discuss a simple, three-step tool for intervening to address poverty as a health risk, endorsed by the OCFP and targeted at family physicians in office-based practice 2. explore examples of interventions family physicians can employ to address poverty as a risk to health, at individual, community, and societal levels 3. review Canadian evidence linking poverty with health issues including diabetes, heart disease, mental illness, and children‘s health Description: This is our third consecutive year presenting this powerful session on the impact of poverty on health! Evidence continues to reinforce what many family physicians know from practical experience: income is THE greatest determinant of health. While physicians are generally aware of this impact, they are often at a loss as to how to intervene to decrease its effect on the health of their patients and communities of practice. The Ontario College of Family Physicians‘ Committee on Poverty and Health has developed a practical, office-based tool to equip family physicians to directly address inadequate income as a risk to health with patients. Using a case study, this session will introduce the clinical tool, shifting the dialogue about poverty and health from defining the problem to taking action. This session will present practical interventions family physicians across the country can employ in their everyday practices to address the health risks posed by poverty.

F102001 11:15–11:45

Returning Your Patient to Work Avram Whiteman, MD, MPH, CCFP, FCFP, FCBOM, FACOEM, Westmount, QC 713B MTCC

Learning Objectives: 1. understand the role of the family doctor in return to work (RTW) 2. identify barriers (and solutions) to RTW 3. appreciate RTW as a therapeutic modality Description: Returning a patient to work can sometimes be a very difficult undertaking for the busy family physician. This presentation reviews the extent and parameters of this issue, then looks at the common medical and non-medical barriers patients might experience in going back to work after a period of illness or injury. Solutions to these common barriers are discussed. The role of the family physician in this process is clarified, so that roles and responsibilities are clear for the various stakeholders in this process (eg, doctor, patient, employer, insurance company, etc.).

F102083 11:15–12:15

Quality Improvement in the Office: The Quality Book of Tools Frank Martino, MD, CCFP (EM), FCFP, Brampton, ON; Cheryl Levitt, MB BCh, CCFP, FCFP, Hamilton, ON 501 MTCC

Learning Objectives: 1. discuss quality improvement as it pertains to the primary care setting and physician‘s office 2. discover how the Quality Book of Tools can be a resource in the quality improvement process 3. plan first steps for quality improvement in the practice setting

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Description: We are all so busy providing patient care, it is hard to imagine how we can include quality improvement on a day-to-day basis in the office. The Quality Book of Tools is an accessible practical guide to topics on how to improve practice management and clinical care in an evidence-informed way. This session will provide an overview of quality improvement, discuss how to get started with quality, and what skills you can learn to integrate quality in the office. We will be referencing The Quality Book of Tools as a foundation and resource to launch quality improvement initiatives.

F102732 11:15–12:15

The Healing Power of Song Roslyn Schwartz, MD, CCFP, Kingston, ON 711 MTCC

Learning Objectives: 1. discover the power of songs to illuminate and reframe experiences and to support and heal 2. discover a repertoire of songs that can be used in various different contexts 3. describe the therapeutic use of songs in various settings Description: Songs can be a source of inspiration and renewal. They can comfort and support, articulate and illuminate common experiences, and bring new perspectives to life‘s challenges. This performance of original compositions explores the power of song to enlighten and heal. The songs include "Courage, " describing strength in the face of a frightening diagnosis; "Wishing Well," which reframes the experience of disappointment; and "The Village Effect," about the importance of community support. Other, humorous songs—such as "Complaining!" and "Ode to the Parking Lot at Expo 67"—can bring laughter to common misfortunes. The use of these and other songs in various contexts will also be discussed.

F102802 11:15–12:15

Responding to the CFPC Global Health Community of Practice Katherine Rouleau, MD CM, CCFP, Toronto, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. summarize the activities of the Global Health Committee for 2015 2. identify three priority issues around which to engage the CFPC Global Health Community of Practice in Family Medicine 3. develop a summary action plan to engage the CFPC Global Health Community of Practice in Family Medicine

F120750 11:15–12:15

Home Improvements: Using PMH pillars to guide quality improvement activities in family practice clinics

Rob Wedel, MD, CCFP, FCFP, Taber, AB 401 MTCC

Learning Objectives: 1. describe the elements of the Patient‘s Medical Home model that can guide quality improvement (QI) activities in family practice clinics 2. describe QI techniques and the supports they need that can be applied in family practice clinics 3. describe practical examples of QI initiatives that have made a measurable difference in quality of care

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Description: In keeping with the nature of the field of global health itself, the CFPC Global Health Community of Practice in Family Medicine is highly diverse. This diversity has challenged the ability of the Global Health Committee to engage members more fully. During this session, participants will be asked to identify the three most pressing needs of the community of practice and to propose actions to begin to address them.

Description: Though we recognize our need to continuously work toward improving the care we provide in our clinics, the ongoing demands of a busy family practice seem to always get in the way. The Patient‘s Medical Home (PMH), CFPC‘s vision for family practice, is a model that can act as a focus and a guide to our improvement activities. The model is intentionally flexible, allowing us to define and prioritize directions based on our clinics‘ unique needs and community characteristics. The experiences of clinics across Canada are showing that successful improvement initiatives can be undertaken by utilizing the pillars identified in the PMH, along with the known principles of quality and process improvement. The resources needed will include physician leadership, some dedicated staff time, and basic measurement and facilitation tools. Examples of successful activities, along with practical, available resources, will be discussed.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F101615 11:45–12:15

Chronic Non-Cancer Pain Management in Patients With Addiction John R. Fraser, MD, CCFP, FCFP, Halifax, NS 701AB MTCC

Learning Objectives: 1. apply strategies to manage CNCP patients with a history of addiction and with active addiction 2. identify the differential diagnoses of opioid-related aberrant behaviours in CNCP 3. apply strategies to determine the cause of and manage opioid-related aberrant behaviours in CNCP Description: The incidence of addiction in chronic non-cancer pain (CNCP) patients is estimated to be 19 to 26 per cent. Opioid therapy is a common strategy in chronic pain management, but opioid prescribing in patients with addiction can pose significant risks and challenges. Patients with comorbidities of chronic pain and addiction can be separated into three groups: 1) patients with a history of addiction, 2) patients with active addiction, and 3) patients in whom the diagnosis of addiction has not been clearly established but is suspected due to the presence of recurrent opioid-related aberrant behaviours. In the latter group, there are various explanations for aberrant behaviours that are not related to addiction and thus careful consideration of the differential diagnosis is important. This session will provide recommendations regarding the use of opioids in CNCP patients with a history of addiction or with active addiction. The focus of the session will include a discussion of the differential diagnoses related to aberrant behaviours, and guidance on how to determine the diagnosis and how to manage it.

F123179 Estate, Will, and Charitable Planning 12:15–13:15 Elaine Blades, Director, Fiduciary Services, Scotia Private Client Group, Scotiabank, Toronto, ON; Paul Fensom, Director, Scotia Private Client Group, Scotiabank, Toronto, ON 713A MTCC Description: Plan for your practice, your family, and your legacy. Plan to attend this important Scotiabank seminar on estate and charitable planning.

Understand why you need a will, gain insight into the tax implications of your bequests, consider what will be required of your executor, and learn how important it is to prepare a power of attorney. This session will provide important information on all of these issues, as well as give you options for charitable planning as part of your legacy. A question-and-answer period will follow.

F119829 A 12:30–13:30

FPAGC Respiratory Updates: Visiting new and current data in COPD Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON 801AB MTCC

Learning Objectives: 1. optimize knowledge on disease-state and interventions to prevent, diagnose, and manage COPD and to reinforce and measure behaviour change through multi-touch point testing 2. recognize the role of new and emerging treatments and implement practical tools and strategies into day-to-day practice to help improve patient outcomes 3. measure knowledge transfer, uptake of key messages, and behaviour change using Moore’s Outcomes Framework for Planning and Assessing CME and disseminate results through peer-reviewed publications Description: Respiratory diseases affect at least 20 per cent of Canadians, with over 3 million Canadians having serious respiratory disease such as asthma or chronic obstructive pulmonary disease (COPD). Asthma is the most common respiratory disease and COPD is largely underdiagnosed, but despite the considerable burden imposed on patients, the management of these respiratory diseases remains suboptimal. The Family Physician Airways Group of Canada (FPAGC) has designed a program to meet the needs of primary physicians, physician assistants, registered nurses, and other primary care providers who treat patients with asthma or COPD. This program is accredited for one Mainpro M1 credit and includes multiple choice questions and case-based assessments.

Participants may claim an additional Mainpro-M1 credit for attending this session

V101201 Publier en français dans Le Médecin de famille canadien 13:45–14:45 Roger Ladouceur, MD, CCMF, FCMF, Verdun, QC; Yves Lambert, MD, CCMF, FCMF, Longueuil, QC; Suzanne Gagnon, MD, CCMF, FCMF, Quebec, QC 712 MTCC Objectifs d‘apprentissage : 1. découvrir les avantages de publier en français dans le Médecin de famille canadien 2. connaître les exigences et les directives aux auteurs 3. comprendre le rôle des réviseurs et des rédacteurs Description : Cet atelier permettra aux participants de découvrir les possibilités et les avantages de la publication en français dans Le Médecin de famille canadien. Ils passeront en revue les types d‘articles pouvant être soumis, les directives aux auteurs ainsi que les directives concernant chaque catégorie d‘articles. La façon de soumettre un texte et le processus d‘évaluation par les pairs seront également abordés. L‘atelier se veut interactif et participatif. Des exemples et des séances pratiques sont prévus.

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F96972 13:45–14:45

Family Physicians Can Prevent ACL Injuries ... Really!

James Carson, MD, CCFP, FCFP, Dip Sport Med, Toronto, ON hall g MTCC

Learning Objectives: 1. become advocacy champions in their communities to prevent over 75% of ACL injuries 2. discuss the evidence-based research that supports the usage of the FIFA 11+ prevention exercises by all youth soccer teams across Canada 3. identify and optimally manage ACL injuries until they can return patients to play Description: This presentation will be based on the recent position statement published by the Canadian Academy of Sport and Exercise Medicine on ACL injury prevention. Participants will learn about the spectacular potential of neuromuscular training programs to prevent ACL injuries in youth sports such as soccer. ACL injury evaluation and management by the family physician will also be discussed.

F99344 13:45–14:15

Turning "Queasy" Into Easy: Simple approaches to nausea in palliative care Stephen Singh, MD, CCFP, Cert Pall Med, Ancaster, ON; Mireille Lecours, MD, CCFP, Stratford, PE 802AB MTCC

Learning Objectives: 1. identify the relevant receptors involved given a patient case of nausea 2. logically choose an anti-nauseant depending on the type of receptors involved 3. re-evaluate and treat refractory nausea Description: Nausea is a common and distressing symptom in the palliative care setting. The underlying cause of a patient‘s nausea will dictate the ideal choices of anti-nauseants. Sometimes this choice can seem daunting. This talk will discuss an easy, logical overview of nausea pathways. Using cases, we will discuss possible choices for anti-nauseants depending on the receptors involved. Lastly, we will discuss refractory nausea and its possible treatment. You will leave feeling more confident about nausea and its management.

Live tweeting during this talk will allow for group online discussion and networking.

The Everlasting Song: Music and doctors – from medical school to retirement Ted Jablonski, MD, CCFP, FCFP, Calgary, AB 711 MTCC

Learning Objectives: 1. recognize the connection between music and physicians‘ health through anecdotal stories, historical reference, and scientific literature review 2. define various proto-typical “life cycles” of music in physicians‘ careers 3. employ a simple tool to maximize the healing role of music throughout career transitions Description: While music therapy is increasingly recognized as an adjunctive therapy for palliative care, geriatrics, and childhood illnesses, the use of music as a self-therapeutic tool for the physician is less well established. It is often said that there is an unusually high number of physicians that are musicians (or perhaps, more correctly, musicians who happen to become doctors). This presentation will explore the important connection between music and medical practitioners. In their formative years many future physicians mastered a musical instrument, played in bands or orchestras, or sung in recitals---music being a significant part of their lives. With busy residencies, early career responsibilities, and the start of families, the pursuit of music is commonly left behind as a “luxury” that limited time no longer affords. As careers and families mature, physicians sometimes lament the loss of their “musical soul” and either try to revive it or allow its death, living vicariously through their children‘s (or patients‘) musical pursuits. At retirement the goal of learning a musical instrument or singing in a community choir is not uncommon, and physicians feel a spiritual rebirth as music is re-introduced into their lives. Many physicians believe in the importance of music and its healing powers but are sometimes the first to abandon it. This presentation will introduce a simple tool that can be used by practitioners at any time in their career to tap into the healing power of music in their lives, to introduce/explore or to re-introduce and enhance. Whether it be classical violin or hiphop, electronica or aboriginal drumming, the power of music in our personal and professional lives will be explored and celebrated.

Ted “dr j” Jablonski is an award-winning multi-instrumentalist singer-songwriter and family physician in Calgary. Classically trained in piano as a child, he has released seven independent CDs in blues/folk genre, and has had numerous television appearances and some radio play throughout Canada, USA, Europe, and Australia.

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F100365 13:45–14:45

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F101427 The Best of Both Worlds: Ensuring optimum health in refugee populations 13:45–14:45 Meb Rashid, MD, CCFP, Toronto, ON; Praseedha Janakiram, MD, CCFP, Toronto, ON; Vanessa Wright, RN-EC, Toronto, ON; Vanessa Redditt, MD, CCFP, Toronto, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. understand the demographics of refugee migration to Canada 2. plan an approach to the most common health issues that confront refugee populations 3. understand health insurance coverage available to refugee patients and how health care workers have advocated to obtain such coverage.

Description: Over 25,000 refugees are accepted to stay in Canada each year. Many have endured unimaginable pre-migration stressors including exposure to war, torture, and sexual violence. Most originate from source countries where the epidemiology of disease is different than within the Canadian context. Many have not had access to primary care before their arrival in Canada. Many have nuanced health issues that differ from other immigrants and from patients that are Canadian-born. For example, current Canadian research shows high rates of PTSD, depression, infectious diseases, and unmet contraceptive needs. This workshop will provide a background into the demographics of refugee migration to Canada. Using case-based approaches, it will provide participants with an approach to dealing with health issues in different groups of refugee patients in the primary care setting. It will review issues such as immunization needs, screening for infectious diseases, women's health, and recognizing and addressing mental health issues in refugee populations. Given recent changes to health insurance coverage for refugee patients, the workshop will update the current status of the Interim Federal Health Program (IFHP), which provides insurance coverage for refugee patients. Health care workers have been at the forefront of advocating against cuts to the IFHP and the workshop will provide a background into the strategies that have been used to ensure newly arrived refugees have access to primary care.

F101663 13:45–14:45

Rapid-Fire Pearls for Common Practice Problems Tir rapide de perles pour les problèmes courants de la pratique

Tina Korownyk, MD, CCFP, Edmonton, AB hall f MTCC

Learning Objectives: 1. apply simple solutions to common questions that arise in primary care 2. understand the evidence or lack thereof for certain medical practices Description: This is a rapid-fire, Jeopardy-style presentation. Multiple topics will be covered, ranging from pediatric infectious disease, to supplements, to care of the elderly. Key evidence will be presented briefly and the bottom-line answers to relevant clinical questions.

Objectifs d‘apprentissage : 1. appliquer des solutions simples aux questions souvent posées en soins primaires 2. comprendre les données, ou l‘absence de données, justifiant certaines pratiques médicales Description : Cette présentation est un tir rapide, du style Jeopardy. Elle couvre de multiples sujets, allant des maladies infectieuses de l‘enfance aux suppléments, en passant par les soins aux personnes âgées. Des données importantes sont présentées brièvement et les résultats répondent aux questions cliniques pertinentes. La participation de l‘auditoire et l‘interaction sont encouragées.

F101678 13:45–14:15

Facilitating Entry to Psychosocial Treatment for Patients With Substance Use Disorders Yelena Chorny, MD, MSc, CCFP, ABAM, Guelph, ON 501 MTCC

Learning Objectives: 1. identify the different types of psychosocial interventions that are available for treatment of substance use disorders 2. determine an appropriate level of care for initial treatment of substance use disorders 3. identify where to get assistance with finding and accessing psychosocial treatment for patients with substance use disorders Description: Patients with substance use disorders are commonly encountered in primary care. They present with a wide range of severity, medical and psychiatric co-morbidities, personal strengths, external supports, and levels of readiness to change. While family physicians provide a number of effective pharmacological and non-pharmacological interventions in the primary care setting, many patients will benefit from additional support or more intensive psychosocial treatment. Barriers to accessing and completing treatment are many, and lead frequently to frustration on the part of both the patient and the referring clinician. This presentation will help practising physicians identify the psychosocial treatment options available for patients with substance use disorders in their practice, along with clinical criteria that may be used to select an appropriate type and level of treatment. Barriers to treatment at the patient, provider, and systemic levels will be reviewed, and (provincespecific) resources for finding and accessing treatment will be shared.

F94660 13:45–14:45

Five Fundamentals of Civility for Physicians Michael Kaufmann, MD, CCFP, FCFP, Toronto, ON; Ted Bober, MSW, RSW, PHP, Toronto, ON 715B MTCC — Small group interactive workshop – limited seating.

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Learning Objectives: 1. define civility as relevant to the behaviour of doctors in the professional environment 2. recognize the impacts of professional behaviour, both civil and uncivil, on colleagues, co-workers, health care teams, and patient care 3. identify a grouping of strategies that are associated with and promote civil professional comportment among doctors and integrate them into your professional training and practice Description: In recent years there has been increasing attention placed upon physician behaviour in the workplace, mostly in a negative sense.

As a result, a variety of approaches have been developed to address so-called disruptive behaviour by doctors. Less has been written about the understanding and promotion of a desired style of physician behaviour that can be conceptualized as civility. Civility is about more than politeness and courtesy, although it begins there. High-quality professional comportment is essential for health care teams to function effectively. Physician incivility, often revealed at times of tension, can cause stress, distress, and poor productivity in co-workers of all kinds. Incivility can propagate itself and erode the very culture of a workplace and, indeed, a profession. On the other hand, civil behaviour results in positive social interactions. Civility among colleagues is associated with lower rates of professional burnout. Civil collegial relationships create comfortable and energizing workplaces with lower turnover rates and higher worker satisfaction. Everyone, including patients, benefits from civil professional behaviour. The impacts of civility (and its absence) in the professional environment, even if self-evident, have been demonstrated by research and the evidence will be reviewed in this workshop. Even so, the various dimensions of civility do not always surface in a deliberate manner in medical training and beyond. It appears, then, that a civil approach to physician behaviour in the workplace has merit, but there are questions to explore. When the many dimensions of civility are reviewed, it appears that there are specific strategies that can be adopted to foster civil behaviour in doctors, even at times of risk. A practical selection of these strategies, grouped into five categories as “Five Fundamentals of Civility for Physicians,” are respect others, be aware, communicate effectively, take good care of yourself, and be responsible. These Five Fundamentals are offered as a framework for the promotion of civil professional behaviour in doctors at all career stages. A variety of ideas as to how to build upon this framework will be explored.

F101900 13:45–14:45

From Great to Outstanding: Take your medical presentations to the next level – a review of the literature, best practices, and idea-sharing

Simon Moore, MD, CCFP, Mono, ON 707 MTCC

Description: Many physicians are required to present at rounds, conferences, and teaching sessions—and some doctors even enjoy doing so.

However, physicians are often not formally trained to give high-impact presentations. This presentation will overview the published literature on what makes an effective medical lecture and what improves learning outcomes, summarize pearls on the best practices for use of visual aids, and review common presentation pitfalls and how to easily overcome them. This session‘s experienced presenter has often been asked by audience members “how to give a talk.” In response, he will share what he has learned over the years giving medical lectures and the top negative and positive feedback items he (and other conference speakers) have received.

Finally, through a facilitated discussion, participants will have an opportunity to share the techniques they have used to increase the effectiveness of their medical presentations and to learn about others‘ techniques.

F102088 13:45–14:45

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Learning Objectives: 1. discuss the published literature on increasing the effectiveness of medical presentations 2. list best practices for more effective use of visual aids (i.e. Prezi, PowerPoint) and overcome presentation pitfalls 3. discover presentation tips and pearls from other attendees and share your own

Becoming a Resident: It‘s not as bad as you think!

Michelle van Walraven, MD, CCFP, Barrie, ON 709 MTCC

Learning Objectives: 1. prepare for transitioning from being a medical student to a family medicine resident 2. use other residents‘ tips and recommendations on CaRMS, financial concerns, and self-wellness to begin planning for residency 3. discover answers to questions about being a new resident in family medicine Description: It seems like only yesterday you were accepted into medical school. But when should you start thinking about residency? Whether you are in your first or your last year of medical school, it‘s not too early to start planning for the transition. This session for medical students will present some tips and recommendations to help with preparing for residency. It will touch upon the many steps along this natural continuum, including preparing for electives, getting ready for CaRMS, selecting a family medicine residency program, and dealing with financial concerns, lifestyle issues, and adjustment into your new role of being a doctor. This session is presented by a current resident and a recent graduate in family medicine, with participation from the Section of Medical Students and the Section of Residents of the CFPC.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F102150 13:45–14:45

Pearls for Menopause Management: I‘m ready – now what?

Susan Goldstein, MD, CCFP, FCFP, NCMP, Toronto, ON 701AB MTCC

Learning Objectives: 1. describe the new evidence-based guidelines related to menopause management 2. develop an approach to managing and treating menopausal symptoms 3. use newly developed practice tools for menopause management Description: Physicians continue to endorse knowledge gaps around deciding what to treat, when to treat, and how to treat menopausal symptom presentations. After reviewing the newest evidence-based guidelines for menopause management, we will discuss an algorithmic approach to treatment, introduce newly developed practice tools and apps, and will review the specific treatment options. (This presentation has been developed as a follow-up to the presentation at FMF 2012 – Menopause Pearls for Practice.

F102306 13:45–14:45

Managing Medevacs in Rural and Remote Family Practice: Do‘s and don‘ts W. Alexander Macdonald, MD, CCFP, FCFP, Iqaluit, NU 717B MTCC

Learning Objectives: 1. learn the importance of knowing the medevac system's role in the provision of quality care in rural and remote family practice 2. develop a short list of do‘s and don‘ts regarding management of medevacs in rural and remote family practice 3. explore actual cases illustrative of the challenges involved in managing medevacs in rural and remote family practice Description: Managing emergency air medevacs is an integral part of rural and remote family practice in Canada. A thorough knowledge of the physiology of flight and of the logistics of the provincial/territorial medevac system is critical to providing high-quality care to our patients. Based on experience in Nunavut (over 1,700 air medevacs per year) and other regions of Canada, the session will focus on developing a short list of do‘s and don‘ts of air medevac management for family physicians working in rural and remote practices. Flight physiology will be addressed in the context of understanding the impact of the logistics of air medevacs on clinical decision making. The discussion will focus on the family physician as 1) the base hospital physician arranging medevacs coming to the hospital; 2) the sending physician for medevacs to tertiary care centres; and 3) the accompanying physician on acute-care air medevacs. Several actual case histories will be discussed to illustrate the challenges of managing medevacs, and participants will be encouraged to present some cases from their own practices for group consideration. Participants should come away from this session with a good knowledge of the salient points of managing air medevacs.

Through an iterative process we will develop a short list of do‘s and don‘ts for improving the management of air medevacs. With participants‘ permission, the presenter will email the short list of do‘s and don‘ts to all participants after the session.

F102329 13:45–14:45

Where Is Continuity of Care in a Family Medicine Residency Program?

Résidence en médecine familiale : où est la continuité des soins?

Manon Denis-LeBlanc, MD, CCFP, St Isidore, ON; Lyne Pitre, MD, CCFP, FCFP, Ottawa, ON 705 MTCC

Learning Objectives: 1. define continuity of care in family medicine as described by the College of Family Physicians of Canada 2. describe realistically where the residents encounter continuity of care 3. construct appropriate tools to demonstrate how continuity of care is achieved in your residency program Description: Continuity of care is the basis of family medicine practice. However, in a residency program, with all the skills and knowledge that must be taught, it is often difficult to ascertain that continuity of care is achieved. It is even harder to demonstrate when accreditation comes along.

Geared to residents and faculty in family medicine, this workshop is aimed at revisiting what is continuity of care, where it is encountered, and how residents can be exposed to the most valuable continuity of care. Also, there are inherent differences between the academic and community settings; these will be defined. Once continuity of care is recognized, it is also imperative to record it in a way that can be demonstrated to the residents, the departments, and the College. This workshop will focus on strategies to define, apply, and record continuity of care. Practical tools will be developed during the workshop.

Objectifs d‘apprentissage : 1. définir la continuité des soins en médecine familiale telle que décrite par le Collège des médecins de famille du canada 2. décrire de façon réaliste où, quand et comment le résident peut assurer la continuité des soins 3. établir des outils pour démontrer comment la continuité des soins a été assurée au programme de résidence Description :

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La continuité des soins de santé est la base de la médecine familiale. Cependant, en résidence, avec toutes les connaissances et habiletés nécessaires à enseigner, il est difficile d‘assurer cette continuité. Ceci l‘est encore plus si l‘on tient compte de l‘agrément.

Le but de cet atelier, qui s‘adresse aux résidents et aux enseignants de médecine familiale, est de répondre aux questions suivantes : qu‘est ce que la continuité des soins?, quand est-elle rencontrée? et comment les résidents peuvent-ils être exposés à l‘importance de la continuité des soins ? Il existe également une difference entre le milieu académique et communautaire, ce qui sera définit lors de la session. Une fois que la continuité des soins a été établie, il est impératif de documenter le processus afin de le démontrer aux résidents, aux départements et au Collège. Cet atelier se concentrera sur les strategies visant à définir, appliquer et documenter cette continuité. Des outils pratiques seront également développés au cours de l‘atelier.

F102338 Building Research Culture and Capacity in Family Medicine: The Canadian landscape 13:45–15:45 Bridget L. Ryan, PhD, London, ON; Cathy Thorpe, MA, London, ON; Stephen J. Wetmore, MD, CCFP, FCFP, London, ON; Merrick Zwarenstein, MD, London, ON; Jamie Wickett, MD, CCFP, Melbourne, ON; Leslie Boisvert, MPA, London, ON 710 MTCC Learning Objectives: 1. discuss strategies to increase research culture and capacity in family medicine in Canada 2. create a distilled list of ideas to pursue and explore possibilities for collaborations across departments 3. identify a set of best practices, which participants can consider implementing in their own departments Description: Participants will explore strategies to increase research culture and capacity in family medicine departments in Canada. This session will be of particular interest to chairs, directors of research, and faculty charged with increasing research capacity in their departments, and to clinicians and teachers interested in conducting research. The Section of Researchers‘ Blueprint for Family Medicine Research Success envisions research as a core component of training, scholarship, and clinical practice. Twenty-six chairs and research directors from all 17 family medicine departments have expressed interest in participating. Representatives from family medicine departments will share and discuss the strategies they have successfully employed to support research culture and increase research capacity. Participants will distil these ideas as a group. Possibilities for collaborations across departments will be discussed.

Participants will leave with a set of best practices that they can consider implementing in their own departments.

Improving Transitions in Care Between Hospital and Home: How house calls are an important clinical intervention

Amanda Condon, MD, CCFP, Winnipeg, MB; Paul Sawchuk, MD, CCFP, FCFP, MBA, Winnipeg, MB 716A MTCC

Learning Objectives: 1. identify high-risk patient populations mostly likely to benefit from home-based primary care 2. list aspects of care beyond medicine that can be delivered in a patient‘s home 3. measure quality indicators and health care outcomes for patients from home-based primary care Description: The pillars of a patient‘s medical home include ensuring timely access to medical care; coordination of care with other team members; providing continuity of care, relationships, and information for patients while providing services to meet the needs of the population. A traditional office-based model makes it difficult to achieve these elements for those patients who are housebound.

Patients are unable to attend office appointments for many reasons: severity of medical illness, mental illness and addiction, transportation issues and lack of caregiver support. When medical needs arise, often the only way to access medical care is a 911 call and an ambulance transfer to the hospital. How are the patients most in need of more intense home and community care identified? What tools exist in Canada to identify high-risk patients? What do we do for them? Do they have improved health outcomes with this level of care? These are a few of the many questions that arise while contemplating a care model that includes this level of in-home care. This session will bring experienced clinicians from multiple jurisdictions together to discuss the challenges, successes, and outcomes with delivering home-based primary care as part of their practice, along with its role in reducing avoidable emergency room visits and hospitalizations.

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F102579 13:45–14:15

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F96052

Doc, I Can‘t Breathe: How to approach this in your office!

Part A: 13:45–16:15; Part B: 16:30–17:30 801AB MTCC

Learning Objectives: 1. use approach to make the correct diagnosis of a dyspneic patient 2. review treatment strategies 3. review follow-up of these conditions in your office Description: Dyspnea is the presenting symptom for many conditions, from respiratory to cardiac to metabolic causes. It is easy to see that a patient is short of breath, but sometimes the cause is less clear. The executive of the Respiratory Medicine Community of Practice of the CFPC will give you a clear review on how to narrow down the differential, come up with the right diagnosis, and institute therapy for the correct issue to maximize your patient‘s recovery. We will help clarify common, uncommon, clear, and difficult issues including asthma COPD, COPD vs CHF, asthma COPD overlap syndrome, and restrictive lung diseases. Come in with questions; you will leave with the answers!

Part A 1. Case and Differential – Elaheh Mousa Ahmadi, MD, Edmonton, AB 2. Tests Required for Work-up – Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON 3. COPD and Restrictive Lung Disease – Suzanne Levits, MD, CCFP, Montreal Part B 4. Asthma – John Li, Mocton, NB 5. COPD versus CHF and Asthma-COPD-Overlap Syndrome – Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON Moderator – Chris Fotti, MD, CCFP, East St. Paul MB QUESTION PERIOD F102690 13:45–14:15

Water Birth Elizabeth Brandeis, RM, Toronto, ON 714AB MTCC

Learning Objectives: 1. describe the current evidence about the safety of water birth 2. describe practice protocols for water birth 3. identify the research gaps about water birth and opportunities for further inquiry Description: Water birth, an alternate method of pain relief for birth, will be explored in this session. The history and current practices of birthing in water will be reviewed. The safety of water birth will be discussed in the context of the research evidence.

F102008 14:15–14:45

Procedural Pain Management in Infants: Translating evidence into clinical practice Vibhuti Shah, MD, MRCP, FRCPC, MSc, Toronto, ON 714AB MTCC

Learning Objectives: 1. describe the epidemiology and potential long-term consequences of procedural-related pain in neonates and infants 2. review the evidence regarding the effectiveness of various pharmacological and non-pharmacological strategies to reduce or prevent pain 3. summarize strategies that can be easily adopted in clinical practice Description: Procedural-related pain continues to be a significant burden in infants and children in both the hospital and community settings. Even a healthy neonate is exposed to a minimum of two painful procedures (intramuscular injection and heel lance) soon after birth. Further, despite the evidence of long-term consequences of cumulative pain in neonates and infants, effective strategies to mitigate pain are not universally adopted by health care professionals who provide care of these vulnerable infants. In this session, we will review the evidence regarding the burden of illness, the potential long-term implications of cumulative pain, and the effectiveness of various pharmacological and non-pharmacological strategies to prevent or reduce procedural-related pain. At the end of the session, strategies that can be easily implemented by clinicians in office settings will be summarized.

F102483

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13:45–17:30 Louise Nasmith, MD CM, CCFP, FCFP, Vancouver, BC; Ian M. Scott, MD, CCFP, FCFP, Vancouver, BC; Guillaume Charbonneau, MD, CCMF, Messines, QC 717A MTCC Learning Objectives: 1. develop leadership attributes and skills 2. describe a model for analyzing change 3. discuss leadership career development Description: This dynamic workshop on developing leadership skills and attributes is offered to the 34 recipients of the Family Medicine and Medical Student Leadership Awards, and led by three of the College‘s most talented leaders and educators, Drs Louise Nasmith, Ian Scott, and Guillaume Charbonneau. The workshop is offered by invitation only.

F115034 Instilling Social Accountability and Addressing the Hidden Curriculum in Postgraduate Medical 13:45–16:15 Education: Recommendations from the Future of Medical Education in Canada Postgraduate (FMEC-PG) Implementation Project Nick Busing, MD, CCFP, FCFP, Ottawa, ON; Jill Konkin, MD, CCFP, FCFP, Edmonton, AB; Roger Strasser, MBBS, BMedSc, MCISc, DA, DipRACOG, FRACGP, FRACRRM, FRCGP, AM (Australia), Sudbury, ON; Jim Rourke, MD, CCFP (EM), MClinSc, FCFP, FRRMS, FCAHS, LLD, St John‘s, NL 703 MTCC Learning Objectives: 1. describe best practices in social accountability in residency training programs by examining the diversity of learning environments 2. identify the hidden curriculum within our undergraduate and postgraduate training programs and develop strategies to address the negative aspects of this curriculum

F102290 14:15–14:45

HIV Risk, Testing, and Prevention: Practical advice for in-office intervention Charlie B. Guiang, MD, CCFP, Toronto, ON; Gord Arbess, MD, CCFP, Toronto, ON 716B MTCC

Learning Objectives: 1. identify opportunities in the office to assess HIV risk, test when appropriate, and provide risk-reduction counseling 2. using the session‘s practical advice, discuss HIV risks with patients in an open, comfortable, nonjudgmental environment 3. review PEP for patients with potential HIV exposure, including evidence for HIV risk reduction, appropriateness, and counseling

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Description: To better understand how individual residency programs are addressing the issue of social accountability, the FMEC-PG project developed and disseminated a survey to all program directors. The survey asked about the diversity of learning environments that can reinforce our collective social accountability mandate, and explored issues such as scholarship in social accountability. We will present the survey‘s results, then will break into small group discussions to look at best practices in addressing social accountability, as well as barriers and challenges to these practices. The FMEC PG project‘s recommendation relating to the learning and work environment has a number of action items, one of which is to address the positive and negative aspects of the hidden curriculum. The Working Group addressing this issue has identified the following challenges: How can programs increase awareness among learners of the hidden curriculum and its messages? How can programs take stock of their hidden curricula? What reflective strategies will reveal the hidden curriculum so that its messages can be appreciated, critiqued, and mitigated if necessary? How can programs be more deliberate in their use of role models in clinical teaching? The workshop will put forward these issues, and participants will be asked to work towards finding common approaches and solutions to addressing them.

Description: Approximately 71,300 people in Canada were living with HIV in 2011 (prevalence). New HIV infections (incidence) have remained relatively stable in Canada over the years. In 2011, the incidence of HIV infection was approximately 3,175. There were an estimated 65,000 people in Canada living with HIV infection by the end of 2008. The Public Health Agency of Canada estimates that among these, 16,900 people, or 26 per cent, were not aware of their Infection. Family physicians are pivotal in many aspects of HIV prevention. We can assess HIV risk in all our patients, decide appropriately for HIV testing, and provide risk-reduction counseling for those same individuals. Identifying new HIV patients and connecting them to the proper resources gives these patients an opportunity to reduce their viral load with antiretroviral medication and potentially reduces the burden of HIV with the notion of treatment as prevention. Post-exposure prophylaxis (PEP) exists to decrease HIV risk after a high-risk exposure—family physicians are often the first

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE clinicians aware of such exposures and can intervene at a most crucial time. Intended for family physicians, residents, and medical students, this session will review basic HIV epidemiology, highlighting the need for ongoing HIV prevention strategies. The need for proper HIV risk assessment of all patients by their family physicians will also be highlighted. Acknowledging the most common risk factors for HIV in Canada, we will provide practical advice about what to ask, and how to ask it, in the office setting. We will highlight common daily clinical scenarios where opportunities exist to include HIV risk assessment and testing. Understanding HIV test results and their limitations will be reviewed.

Recognizing acute HIV infection, as well as late-stage manifestations in those where HIV diagnosis is missed, will be considered. Finally, we will review PEP for patients with potential HIV exposure, including appropriateness, the importance of timely intervention, and the reduction in HIV risk it can provide. By the end of the session, family physicians will be equipped to take a considerable role in the overall reduction of HIV burden in their communities.

F102698 Benzodiazepines and BZD Use Disorder: A primary care approach to tackling the black box 14:15–14:45 Benzodiazépines et trouble de consommation des benzodiazépines : approche de soins primaires pour s'attaquer à la boîte noire

Jonathan Bertram, MD, CCFP, Toronto, ON; Francesca Di Paola, MB ChB, CCFP, Toronto, ON 718AB MTCC

Learning Objectives: 1. describe effective approaches to screening and assessment 2. address complications of withdrawal and indications for inpatient detoxification 3. identify existing and novel options for taper and pharmacotherapeutic management in the community, including low-dose BZD maintenance Description: There is a high rate of benzodiazepine (BZD) use in the population. Used for multiple indications (anxiety, seizures, alcohol withdrawal, muscular relaxation), BZDs are also addictive substances, and a notable percentage of regular users develop dependence. There is currently no approved pharmacotherapy for treatment of benzodiazepine use disorder, and optimal strategies for assessment and treatment are unclear.

Topics will include the emergence of benzodiazepine and sedative hypnotic use and dependence in both the mainstream and older adult populations; the subsequent complications encountered, especially in relation to withdrawal and when and how a medicalized detox can help; evidence around the classical approach, providing a slow taper associated with counseling; the growing use of pharmacotherapy for subacute withdrawal management; the long-term strategies of maintenance therapy (with BZDs) that could provide some clinical benefit but have not yet been tested appropriately. This session will include didactic and interactive components to encourage discussion. Participants will gain an enhanced understanding of BZDs and use disorder.

Objectifs d‘apprentissage : 1. décrire les approches efficaces de dépistage et d‘évaluation 2. aborder les complications liées au sevrage et les indications de la désintoxication à l‘hôpital 3. nommer les options nouvelles et existantes de retrait graduel et de prise en charge pharmacothérapeutique communautaire, y compris le traitement d‘entretien par une benzodiazépine à faible dose Description : Le taux d‘usage de benzodiazépines est élevé dans la population. Administrées dans beaucoup d‘indications (anxiété, crises convulsives, sevrage de l‘alcool, relâchement musculaire), les benzodiazépines peuvent aussi créer une dépendance, et d‘ailleurs, un pourcentage notoire d‘usagers réguliers en développent une. À l‘heure actuelle, il n‘existe aucune pharmacothérapie homologuée pour le traitement du trouble de consommation des benzodiazépines, et les stratégies optimales d‘évaluation et de traitement sont nébuleuses. Les sujets de cet atelier sont l‘émergence de l‘emploi des benzodiazépines et des sédatifs hypnotiques et de la dépendance à leur égard tant dans la population générale que chez les personnes âgées; les complications subséquentes, surtout en relation avec le sevrage, et quand et comment une désintoxication médicalisée peut être utile; les données étayant l‘approche classique, qui consiste à retirer graduellement le traitement associé au counseling; le recours croissant à la pharmacothérapie pour la prise en charge subaiguë du sevrage; les stratégies à long terme de traitement d‘entretien (par les benzo) qui pourraient procurer des bienfaits cliniques, mais qui n‘ont pas fait l‘objet de tests appropriés. L‘atelier comporte une facette didactique et une facette interactive visant à encourager la discussion. Les participants comprendront mieux les benzodiazépines et les troubles de la consommation.

F95713 Delirium in Palliative and Elder Care: Useful tips for identifying and managing a distressiing problem 15:15–16:15 Gail Saiger, MD, CCFP, FCFP, diploma in palliative care, Victoria, BC; Daphna Grossman, MD, CCFP, FCFP, Toronto, ON 701AB MTCC Learning Objectives: 1. identify delirium and develop an approach to investigation of reversible causes 2. recognize which patients and which medical conditions may be especially susceptible to delirium (advanced cancer, dementia, kidney and/or liver failure) 3. describe pharmacologic and environmental approaches to management of delirium in various settings (home, residential care, hospital) Description: This session will be presented jointly by Dr Gail Saiger, a palliative care physician (with special interest in complex pain and delirium management) who works on a tertiary palliative care in-patient unit in Victoria, BC, and by Dr Daphna Grossman, who works in palliative care at a geriatric hospital in Toronto. Using a combination of didactic teaching and case studies, they will attempt to demonstrate how delirium in elder and end-of-life care is common, ubiquitous, often predictable, and always unsettling. They will offer tools for identification, investigation, and treatment of reversible causes of delirium; discuss the importance of environmental manipulation to manage the distress of fmf.cfpc.ca

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delirium; and offer appropriate pharmacologic suggestions for prevention and management of delirium. Dr Saiger will concentrate on delirium in advanced cancer; Dr Grossman will discuss delirium in the elderly and those with non-cancer diagnoses.

F99343 15:15–16:15

ALS Primer: A palliative approach Stephen Singh, MD, CCFP, Cert Pall Med, Ancaster, ON; Mireille Lecours, MD, CCFP, Stratford, PE 802AB MTCC

Learning Objectives: 1. recognize signs and symptoms of ALS at various stages 2. discuss interventions that can prolong life and/or increase quality of life 3. understand the importance of an interdisciplinary team in ongoing management Description: Amyotrophic lateral sclerosis (ALS) is a devastating, incurable disease currently affecting almost 3,000 Canadians. In this talk, we will discuss some of the signs of ALS at various stages. Through a case study, we will discuss some of the symptoms of ALS and how a palliative care approach can help with management to improve quality of life. Riluzole will be discussed as a possible treatment to prolong tracheostomy-free survival. The importance of an interdisciplinary team will be examined. You will leave feeling more confident about ALS symptoms and their management. Live tweeting during this talk will allow for group online discussion and networking.

F100906 Using Video to Teach Interview Skills 15:15–17:30 William Eaton, MD, CCFP, FCFP, St John‘s, NL; VIna Broderick, MD, CCFP, FCFP, St John‘s, NL; Heather Flynn, MD, St John's NL; Steve Lee, MD, CCFP, FCFP, St John‘s, NL 709 MTCC – Small group interactive workshop – limited seating.

Learning Objectives: 1. recall novel protocol for teaching interview skills using video review of recorded resident-patient interactions 2. reproduce approaches to teaching using video review 3. apply the novel protocol to teaching plans

We wish to present a novel protocol for family medicine preceptors for video review teaching sessions with family medicine residents and clerks. This novel protocol breaks the interview into sections, each requiring unique interview skills. We will discuss how the educational contract helps the resident focus on specific interview skills and how the preceptor’s feedback can reinforce this learning.

We will present a series of video-recorded interactions between residents and mock patients and between these residents and preceptors reviewing the resident-mock patient interviews.

Using this novel protocol will help family medicine preceptors to focus their teaching efforts on resident learning needs.

F101343 Reefer Madness From Cradle to Grave: Considering medical marijuana 15:15–16:15 Lisa Graves MD, CCFP, FCFP, Ancaster, ON; Sharon Cirone, MD, CCFP(EM), FCFP, Toronto, ON;

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Description: As part of the educational mandate of family medicine residencies, community preceptors provide now, and will into the future, much of the ongoing teaching of clinical skills for family medicine residents, especially how to conduct a patient-centred interview.

Family medicine is the main, if not only, discipline that teaches such skills using video review.

Mel Kahan, MD, CCFP, FCFP, Toronto, ON; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON 401 MTCC Learning Objectives: 1. describe the evidence for use of marijuana (dried cannabis) in treatment of medical conditions 2. outline the risks of marijuana use for teens, young children, pregnant women, and breastfeeding mothers 3. use the guidance document to support clinical decision making Description: Recent changes in the regulation of medical marijuana have created challenges for family physicians. The risks of marijuana to young children, adolescents, and pregnant and breastfeeding women will be reviewed. Participants will be able to use the CFPC's preliminary guidance document to guide clinical decision making surrounding the authorizing of marijuana use in chronic pain and in the presence of specific mental health concerns. Participants will develop an approach to requests for marijuana in day-to-day practice. This workshop will lead participants through the 2014 guidance document Authorizing Dried Cannabis for Chronic Pain or Anxiety.

F101484

Stories in Family Medicine: AMS-Mimi Divinsky awards

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE 15:15–17:30

Joyce Zazulak, MSc, MD, CCFP, FCFP, Hamilton, ON 711 MTCC

Learning Objectives: 1. recall stories that bear witness to the physician-patient relationship and the power of humanity in care delivery 2. recognize how stories can help family physicians communicate their values and beliefs to students, residents, and colleagues 3. find inspiration to put thoughts on paper and submit stories to the project Description: ”When Stories nestle in the body, soul comes forth.”–Deena Metzger, poet, novelist, essayist, storyteller, teacher, healer, and medicine woman.

Family physicians have traditionally relied on scientific evidence to guide care for their patients. New research is encouraging physicians to tell their own stories of caring for patients as a way to rehumanize medicine. This type of reflection can help physicians develop empathy and a greater understanding of the patient’s experience of illness. These stories, now a connection between the doctor and the patient, can ultimately guide in delivering patient-centred care.

Join us to hear the stories written by the recipients of this year’s AMS-Mimi Divinsky awards and the insights of our guest lecturer.

F101809 15:15–16:15

Treating High-Risk Chronic Pain Patients: What you need to know to prescribe safely Robert Hauptman, BMSc, MD, St Albert, AB 716A MTCC

Learning Objectives: 1. describe characteristics of high-risk patients 2. describe tools to assess and stratify patients with chronic pain into low-, moderate-, and high-risk categories 3. implement strategies and boundaries in managing high-risk patients with chronic pain Description: Chronic pain afflicts thousands of Canadians. Current estimates are that 20 per cent of Canadians suffer from chronic pain. Of particular difficulty for physicians is treating patients with chronic pain who have a past history of addiction, a family history of addiction, or a current substance abuse problem. These patients with chronic pain are at high risk for medication misuse and diversion. However, at the same time, they can have significant pain problems. This session will review the management of high-risk chronic pain patients with the goal of increasing participants‘ confidence in managing this group of patients.

F101892 15:15–17:30

Professionalism Issues: An educational opportunity Erika Abner, LLB, LLM, PhD, Toronto, ON; Susan Goldstein, MD, CCFP, FCFP, NCMP, Toronto, ON 705 MTCC

Learning Objectives: 1. discuss approaches one can take with trainees who present professionalism lapses 2. identify different management strategies for different trainee presentations 3. develop specific, targeted reflective assignments and activities Description: Students presenting with behaviours that raise professionalism issues are challenging for family physicians. At the same time, these events are often valuable educational opportunities that offer teachable moments for delivering appropriate feedback. This workshop will help participants to recognize and address common student presentations that raise professionalism concerns, including typical major and minor professionalism lapses. These include, for example, consistently late assignments, poor communication, difficulty prioritizing work, and general disorganization. We will discuss management strategies, resources, and documentation at the student and institutional levels. The workshop will employ a variety of instructional methods, including case-based discussion, document review, and brief lectures.

F102322 15:15–16:15

Mosquitoes Could Spoil Your Vacation: Chikungunya virus and other mosquito-borne diseases Michel Deilgat, MD, MPA, CCPE, Ottawa, ON 716B MTCC

Learning Objectives: 1. review the epidemiology of recent outbreaks in the Caribbean and surrounding countries 2. describe the clinical manifestations and provide a differential diagnosis 3. prescribe the appropriate diagnostic testing and provide effective management

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Description: Since 2005, chikungunya fever, a viral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes, has become a global public health issue. Acute symptoms include fever, rash, backache, headache, and joint pain. Although fatal outcomes are relatively rare, after-effects are common—particularly arthritis, which can persist long-term. In December 2013, the local transmission of the chikungunya virus (CHIKV) was confirmed for the first time in several Caribbean islands. In a given year, Canadians can make more than 2.5 million visits to the Caribbean countries—thus the potential increased risk of travel-related cases. In 2014 alone, the National Microbiology Laboratory confirmed over 100 imported cases of CHIKV diagnosed in Canadian travelers returning from endemic regions, and this number is expected to grow in the coming years. The spread of the disease has reached Central America and South America, and, in 2015, the mosquitoes have been seen for the first time in the San Diego region. A recent assessment by the Public Health Agency of Canada suggests that the current risk of autochthonous (ie, local or indigenous) spread of CHIKV in Canada is very low. However, family physicians must be vigilant to recognize an increased number of cases coming from travelers visiting the southern hemisphere and to provide preventive measures and advice, as no vaccine or specific treatment is available at the moment.

F102477 15:15–16:15

Hypoglycemia: A major reason for not achieving targets Michele MacDonald Werstuck, RD, MSc, CDE, Hamilton, ON; Bruno DiPaolo, BSc, MD, Hamilton, ON 501 MTCC

Learning Objectives: 1. use case-based scenarios to identify the signs and symptoms of hypoglycemia and patients at increased risk 2. describe the implications of hypoglycemia on diabetes and driving and senior health, from a clinician perspective and a patient perspective 3. identify and practice strategies to use in family practice to reduce risk of hypoglycemia, including medication management and patient education approaches

F102493 15:15–16:15

I‘m Not Injecting Poison Into My Child!: How to confidently debunk your patients‘ anti-vaccination myths

Simon Moore, MD, CCFP, Mono, ON; Kaitlin Dupuis, MD, CCFP, Hamilton, ON hall g MTCC

Learning Objectives: 1. review common patient objections to vaccines 2. learn practical facts to counsel patients on the benefits (and the known adverse reactions) of vaccines 3. use patient handouts and practical tools for physicians Description: Counseling a vaccine-hesitant parent goes far beyond knowing how to respond to the myth that “vaccines cause autism.” In an honest effort to keep their children safe, some parents have done extensive research, and ask their physician’s opinion on the incorrect information that they find. Other parents have multiple and sophisticated rebuttals when a doctor suggests their child be vaccinated.

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Description: How often do your patients with diabetes experience hypoglycemia? Balancing the benefits of optimizing care with reducing risk of adverse events such as hypoglycemia is always forefront in the minds of clinicians. Whether it is an elderly patient at risk of falls or atrial fibrillation or a driver living with diabetes, preventing hypoglycemia is the top priority. ”Fix the lows first, then go after the highs” is a common mantra in diabetes education. Our physician-dietitian-nurse practitioner team has developed a collaborative approach to diabetes care, with a focus on hypoglycemia prevention. From medication management options to diabetes education strategies, this session will highlight cases you will commonly see in family practice and discuss how to manage care to reduce hypoglycemia risk and ensure patients receive the hypoglycemia message each and every visit.

Through a dynamic discussion, hosted by two speakers, common patient objections to vaccines will be reviewed, including “The formaldehyde/arsenic/aluminum/mercury in vaccines is harmful”; “Vaccines are made from aborted fetal cells and have baby bits, and my religion opposes this”; “Disease rates were declining before vaccines were introduced”; “My daughter will be more promiscuous if you vaccinate her for HPV”; “It’s better to get the diseases naturally—they’re not so bad”; “A baby’s immune system can’t handle all these”; “The vaccines haven’t been around long enough to know they’re safe.” To review these objections, participants will be shown practical facts and pearls to counsel patients on the benefits (and the known adverse reactions) of vaccines; anti-vaccination literature—along with the science to debunk claims; patient handouts and tools for physicians; and licensing bodies' policies for physicians who refuse to see vaccine-hesitant parents.

Finally, a group discussion will be facilitated to share experiences with patient objections and ways to overcome them.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F102738 Approach to Interviewing the Young Patient With Borderline Personality Disorder: 15:15–15:45 Pearls for practice Approche d'entrevue du jeune patient atteint d'un trouble de la personnalité limite : conseils précieux pour la pratique Natalie Raso, MD Candidate McMaster 2016, BASc, MPP, Hamilton, ON; Olabode Akintan, MD, FRCPC, MBA, Hamilton, ON; Dominik Nowak, MD Candidate McMaster 2016, BSc (Hons), Hamilton, ON 718AB MTCC Learning Objectives: 1. use an evidence-based framework to interview young patients with borderline personality disorder (BPD) in a typical practice 2. develop strategies for building an effective therapeutic relationship with young patients with BPD in a typical practice 3. develop an approach for managing a patient with BPD who presents in a crisis situation Description: Patients with BPD can be challenging to treat. Youth with BPD or BPD-related traits exhibit emotional volatility, self-injurious behaviour, and undergo recurrent crises. Physicians involved are often left feeling overwhelmed, frustrated, and helpless. The condition is associated with an alarming prognosis, as successful suicide rates for this population are 8 per cent to 10 per cent. Although there exists a sound body of evidence supporting specific treatment frameworks for BPD patients, there is nonetheless a paucity of literature and training for family physicians wishing to better care for this demographic in community or critical contexts. This interactive presentation, featuring role-play with simulated patients, will be of interest to generalists, primary care providers, residents, students, and allied health care professionals. We will provide a brief introduction to BPD, including prevalence and prognosis, and then outline the pitfalls and challenges that family doctors face when interviewing and forming a relationship with a patient who has BPD (such as setting boundaries, managing the therapeutic relationship, and setting up appropriate venues for follow-up). Although family doctors might not be providing long-term psychotherapy to their patients with BPD, they can use simple clinical interventions in the primary care setting that can be surprisingly productive. Through role play, we will demonstrate effective techniques for interviewing patients with BPD in a primary care setting, based on principles of dialectical behavioural therapy, which involves establishing goals that are clear and feasible, being direct, and encouraging patients to generate solutions to their problems. Providing care to patients with BPD can be challenging and draining for the family physician. We will also highlight strategies to employ to help manage the stresses that go along with caring for this patient population.

Objectifs d‘apprentissage : 1. utiliser un cadre de travail factuel pour interviewer les jeunes patients atteints d‘un trouble de la personnalité limite en pratique typique 2. élaborer des stratégies visant à nouer une relation thérapeutique efficace avec les jeunes patients atteints d‘un trouble de la personnalité limite en pratique typique 3. développer une approche de prise en charge des patients atteints d‘un trouble de la personnalité limite en situation de crise Description : Les patients atteints d‘un trouble de la personnalité limite peuvent être difficiles à traiter. Les jeunes atteints de ce trouble ou de symptômes connexes font preuve de volatilité émotionnelle, de comportements d‘automutilation et traversent des crises récidivantes. Les médecins se sentent souvent dépassés, frustrés et inutiles. Le trouble est associé à un pronostic alarmant, car le taux de suicide dans cette population est de 8 à 10 %. Bien qu‘un bon nombre de données probantes étayent des cadres thérapeutiques spécifiques pour les patients atteints de trouble de la personnalité limite, il existe néanmoins peu de publications et de formation s‘adressant aux médecins de famille qui souhaitent mieux traiter cette population en contexte communautaire ou critique. Cette séance interactive, qui présente des jeux de rôles avec des patients simulés, intéressera les médecins omnipraticiens, les fournisseurs de soins primaires, les résidents, les étudiants et les professionnels paramédicaux. Nous introduirons brièvement le trouble de la personnalité limite, y compris sa prévalence et son pronostic, puis mettrons en lumière les pièges et les défis auxquels les médecins de famille doivent faire face lorsqu‘ils interviewent et nouent une relation avec un patient atteint de ce trouble (comme établir les limites, prendre en charge la relation thérapeutique et organiser un endroit approprié pour le suivi). Bien que les médecins de famille ne fournissent pas une psychothérapie prolongée à leurs patients atteints du trouble de la personnalité limite, ils peuvent avoir recours à des interventions cliniques simples en soins primaires pouvant être étonnamment productives.

Par l'intermédiaire de jeux de rôles, nous ferons la démonstration de techniques efficaces pour interviewer les patients atteints du trouble de la personnalité limite en soins primaires, fondées sur le principe de la thérapie comportementale dialectique, laquelle implique des objectifs établis qui sont clairs et atteignables, d‘être direct et d‘encourager les patients à trouver des solutions à leurs problèmes. Il peut être difficile et exténuant pour le médecin de soigner des patients atteints du trouble de la personnalité limite. Nous mettrons aussi en lumière des stratégies pour aider à gérer le stress souvent lié aux soins des patients de cette population.

F102749 15:15–16:15

Clinical Population Medicine: Inventing collaborative models for population medicine and clinical practice

Aaron Orkin, MD, MSc, MPH, CCFP, FRCPC, Toronto, ON; Ross Upshur, MD, MA, MSc, CCFP, FCFP, FRCPC, Toronto, ON; Kate Bingham, MD, MSc, CCFP (EM), FRCPC, Toronto, ON; Samantha Green, MD, CCFP, Toronto, ON; Matthew Hodge, MD CM, PhD, CCFP (EM), FRCPC, Toronto, ON; Noah Ivers, MD, PhD, CCFP, Toronto, ON; Fiona Kouyoumdjian, MD, MPH, PhD, CCFP, FRCPC, Hamilton, ON; Onye Nnorom, MDCM, CCFP, MPH, FRCPC, Toronto, ON; Andrew D. Pinto, MD, MSc, CCFP, FRCPC, Toronto, ON; Danyaal Raza, MD, MPH, CCFP, Toronto, ON; Tomislav Svoboda, MD, MSc, PhD, CCFP, FRCPC, Toronto, ON 717B MTCC

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Learning Objectives: 1. define and explore opportunities for shared care between patient-centred clinical practice and population health 2. describe different ways to incorporate population medicine and public health approaches and practitioners into clinical practice 3. invent models for partnership between specialists in family medicine and public health and preventive medicine Description: This workshop will engage participants to develop and advance ”clinical population medicine,” a new approach to shared patient and community health care delivered by family medicine, health organizations, and population health practitioners. Population health issues manifest as clinical problems—from measles outbreaks to uninsured populations, from cancer screening to poverty.

Family doctors work at the front lines of population health issues. Yet public health practitioners and agencies sometimes implement policy and population-level prevention efforts without careful consideration of the role of clinical practice, primary care, and patientoriented services. The result is a critical gap for our patients, our practices, and our communities. Can we collaboratively build our practices, hospitals, and health care systems to better meet community needs? Participants will be challenged to identify ways to close the gap between clinical practice and population health. Workshop organizers will present clinical population medicine as a way of embedding population health expertise into clinical settings. Like other shared care models, the goal is to share responsibility for organizing and delivering care that addresses both patient and community health priorities. We will call on participants to help us develop and critique this model, and determine whether it would serve their patients and practices. We will break into small groups facilitated by family doctors and public health and preventive medicine specialists. Participants will develop an inventory of community and population health needs in family medicine. With specific cases and opportunities ripe for a clinical population medicine approach, participants will explore how these needs present in practice, what resources and expertise would help to address them, and the strategies that would make the effort rewarding and worthwhile. Participants will leave with an enhanced understanding of what clinical population medicine could bring to their practices and communities.

F102777 15:15–16:15

Practice-Based Research for Beginners: Research redefined, simplified, demystified Anwar Parbtani, PhD, MD, CCFP, Barrie, ON; Matthew Orava, MSc, MD, CCFP, Oro-Medonte, ON 712 MTCC

Learning Objectives: 1. define research in context of primary care practice 2. dispel misperceptions that research is alien to primary care practice and only doable in academic institutions 3. initiate practice-based research through a mock exercise and group interactions

F103091 15:15–16:15

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Description: Family medicine is perpetually evolving as new diagnostic and therapeutic modalities are imagined and old dogmas are challenged.

A family physician is hence a lifelong learner who continually evaluates the existing practice and keeps abreast of shifting practice paradigms. Fulfilling this CanMEDS-FM ”Scholar Role” also requires assessing practice modalities through scientific rigour—the crux of practice-based research. However, some primary care providers are reluctant to engage in research, believing that research is a complex, time-consuming exercise, alien to clinical practice and only doable in academic institutions. This interactive session aims to dispel those misperceptions. The workshop moderators begin by defining ”research” in the context of clinical practice, before participants divide into groups to formulate a research question or clinically relevant enquiry. Then, following intergroup discussion, each group refines its question to fit its objectives and value to practice. Finally, each group determines the methodology, data collection, and analysis for its question, learning to keep the project simple and avoid undue complexity. This workshop will be of interest to new researchers, including family physicians, allied health care professionals, and residents/trainees. It will enhance understanding of research in the context of primary care practice and encourage participants to look at research as part of their practice improvement endeavours. It might also result in participants forging long-term collaborations.

Test Your Contraception IQ / Mettez à l‘épreuve vos connaissances sur la contraception Jennifer Blake, MD, MSc, FRCSC, Ottawa, ON hall f MTCC

Learning Objectives: 1. separate fact from myth with respect to common beliefs about birth control 2. identify opportunities to change contraceptive practices, reduce failure, and improve satisfaction 3. reassure patients about the relative safety of contraception and provide information with confidence Description: This session will be presented in a question-and-answer format. Questions about current contraceptive methods and their indications, contraindications, and effectiveness, based on the 2014/2015 updated guideline, will be covered.

Objectifs d‘apprentissage : 1. distinguer les faits des mythes concernant les croyances courantes sur les contraceptifs 2. identifier des occasions de changer les pratiques en matière de contraception, réduire les échecs et améliorer la satisfaction 3. rassurer les patientes sur l‘innocuité relative de la contraception et offrir de l‘information avec assurance

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE Description : Cette séance répondra aux questions sur les méthodes actuelles de contraception et leurs indications, contre-indications et efficacité, selon une formule « période de questions » basée sur la mise à jour 2014-2015 du guide de pratique.

F102364 15:15–17:30

Practical Tips for Teaching Residents to Teach in Busy Ambulatory Care Settings Judy Baird, MD, MEd, FCFP, Dundas, ON; Heather Waters, MD, FCFP, Hamilton, ON 707 MTCC

Learning Objectives: 1. describe a framework for teaching residents to teach, which can be applied in the patient care setting 2. apply the ”Parallel Framework for Teaching to Teach” in the ambulatory care setting 3. apply microskills principles to resolve difficult ”teaching to teach” encounters in the ambulatory setting Description: Clinical preceptors in ambulatory environments are often challenged to provide clinical care and teach learners in layered learning models, under significant time constraints. Helping residents to develop skills as clinical teachers in the midst of these other demands can be extremely challenging. Practical resources to manage this layered teaching are limited. Existing tools are primarily directed at residents themselves, rather than at the clinicians who are supporting the development of resident teaching skills. In addition, residents frequently receive very little direct feedback on their teaching. Many residency programs are developing sets of entrustable professional activities (EPAs), to guide resident competency assessment, among which the ”teaching and supervision of learners” is often included. CanMeds-FM highlights the importance of residents as teachers under the Scholar Role, ”facilitating the learning of ... trainees and health professional colleagues.”

In this workshop, we will review strategies for supporting residents in achieving relevant CanMeds-FM competencies, such as delivering a learner-centred approach to teaching, and assessing/reflecting on a teaching encounter. In this workshop, participants will be introduced to a Parallel Framework for Teaching to Teach, which can be used to support residents in their teaching role. Participants will apply this framework in common teaching scenarios. Participants will be provided with a toolkit of resources for supporting the development of residents as teachers. Strategies to manage difficult ”teaching to teach” situations will be discussed.

F102035 15:45–17:30

Writing for Publication: The 90-minute workshop Frank Sullivan, MD, CCFP, North York, ON 710 MTCC

Learning Objectives: 1. identify the main characteristics of an article that is likely to be accepted by a journal 2. make informed decisions on time management and journal choice 3. set a ”writer‘s brief” by making decisions in five key areas Description: The aim of this workshop is for participants to draft a journal article that has a good chance of being accepted by their target journal.

Participants should bring an idea that they have been meaning to turn into a scientific article for some time. They can expect to complete 80% of the work of writing the article during the workshop and to go away with an electronic support network that will enable them to complete the process over the next month or so. This will be achieved by using a 25-page workbook that has been used effectively in similar conferences with similar groups in the past by the workshop leader, who has published 207 papers in peer-reviewed journals, has undertaken more submissions to journals than he cares to recall, and has been a member of the British Medical Journal‘s ”Hanging Committee.” Some of the session will be didactic, but most of the time will be spent with participants committing their ideas to paper.

F95474 16:30–17:30

Driving and Dementia: Practical tips for the family physician Conduite et démence : Conseils pratiques pour le médecin de famille

Linda Lee, MD, MClSc(FM), CCFP, FCFP, Kitchener, ON hall f MTCC

Learning Objectives: 1. list findings in the cognitively impaired patient that may indicate that fitness to drive is a concern 2. explain office-based tests that can help in the assessment of the potentially unsafe cognitively impaired driver and the role of on-road driving assessments 3. discuss ways of communicating concerns about driving fitness that are less likely to harm the patient-physician relationship Description: With the aging Canadian population and estimates of approximately one-quarter of persons over age 65 suffering from either mild cognitive impairment or dementia, family physicians will be increasingly challenged with concerns about fitness to drive. In most provinces including Ontario, it is mandatory to report potentially medically unfit drivers to transportation authorities. This session will provide the busy family physician with practical tips on dealing with driving fitness in the senior who is cognitively impaired.

Objectifs d‘apprentissage : 1. dresser la liste des observations pouvant indiquer que l‘aptitude à conduire chez les patients atteints d‘un déficit cognitif est une préoccupation 2. expliquer les tests administrés en cabinet pour aider à évaluer un conducteur atteint d‘un déficit cognitif potentiellement dangereux et le rôle des évaluations de conduite sur la route 3. discuter des façons de communiquer ses préoccupations au sujet de l‘aptitude d‘un patient à conduire sans heurter la relation entre le patient et le médecin fmf.cfpc.ca

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Description : Face au vieillissement de la population canadienne et à des estimations selon lesquelles environ le quart des personnes de plus de 65 ans souffrent d‘un déficit cognitif ou de démence, les médecins de famille devront de plus en plus faire face à des préoccupations en matière d‘aptitude à conduire. Dans la plupart des provinces, y compris en Ontario, il est obligatoire de signaler au ministère des Transports les conducteurs potentiellement inaptes à conduire pour des raisons médicales. Cette séance fournit au médecin de famille occupé des conseils pratiques sur la façon de composer avec l‘aptitude à conduire chez les personnes âgées atteintes d‘un déficit cognitif.

F96996 16:30–17:30

Urine Drug Screens: Who, what, where, when, why, and how?

Megen Brunskill, MD, CCFP, Marathon, ON 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. review why urine drug screening is integral to effective and safe chronic pain opioid prescribing 2. identify differences between available urine drug screens and how to interpret/manage the results 3. create a clinic-wide opioid prescribing program that includes systematic random urine drug screening Description: Most available guidelines recommend the routine use of urine drug screening (UDS) for safe opioid prescribing in chronic pain.

This presents many challenges for a busy family physician. A clinic-wide opioid prescribing program systematizes who to screen and when, which simplifies how to incorporate random UDS into your practice. This session will introduce our FHT-based opioid prescribing program including our clinic‘s UDS protocol plus opioid monitoring ladder (a systematic approach to managing UDS results and other aberrant behaviour.) We will review the differences between point-of-care testing products and laboratory confirmatory tests. Common pitfalls in UDS interpretation plus the concept of confirmation testing of unexpected screens will be addressed. Case presentations will be used to demonstrate a stepwise approach to the management of opioid therapy in complicated chronic pain patients. The goal of this session is to have participants leave feeling confident in the use of UDS in their everyday practice.

F99145 Primary Health Care, Health, and Obesity: Lessons across the 49th parallel 16:30–17:30 Lawrence C. Loh, MD, MPH, CCFP, FRCPC, Toronto, ON; Shafik Dharamsi, BEd, MSc, PhD, Vancouver, BC;

Learning Objectives: 1. differentiate the key elements of obesity prevention, management, and outcomes between Canadian and American health care systems, and identify areas of improvement and lessons learned from each system‘s experience 2. identify key elements of success that contribute to effective collaboration on obesity prevention between family medicine and public health in both countries 3. evaluate potential avenues to fight obesity in each national context, with a particular emphasis on activities that promote greater alignment between family medicine and public health practitioners Description: Obesity influences the practice of family physicians (FPs) and public health physicians (PHPs) in Canada and the United States, with collaboration between these groups and clinical approaches having slight variation between national contexts. In both settings, however, multi-component interventions and guideline implementation are typically constrained by inadequate resources, limited time, and isolated practitioners. Each national family practice context has developed promising solutions. Some examples include greater cross-sector collaboration with public health, with the benefit of addressing modifiable risk factors through aligned health promotion efforts, and new interdisciplinary models, such as family health teams in Canada, which provide novel opportunities for knowledge sharing, implementation, and service integration. This session will be of interest to Canadian/American FPs/PHPs; resident physicians and medical students; senior leaders, researchers, and advocates from government, academic, non-profit, and/ or private sectors. Front-line FPs in Canada and the United States confront the complexities of the obesity epidemic together with PHPs, academics, advocates, and government. Engaging participants in all these fields from both sides of the border will help open a conversation and foster the development of a community that is aware of strategies employed in both national contexts and is able to collaborate in applying best practices appropriate to their national context through their clinical and advocacy work. A World Café format will allow representatives from family medicine and other related sectors to compare and contrast Canadian and American obesity prevention approaches within the primary care and public health sector. The aim will be to produce an publishable evaluation of discussed themes that highlights key strategies to addressing the obesity epidemic. Outcomes will be knowledge sharing, professional reflection, development of a community of practice, greater intersectoral collaboration within national contexts, and greater transnational collaboration, data sharing/research, and guideline development/alignment.

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Adam Hoverman, DO, DTM&H, Yakima, Washington; William Cherniak, MD, CCFP, Toronto, ON 802AB MTCC

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE F102304 16:30–17:00

Vision Loss and Diabetes: The primary care practitioner‘s key role in reducing the burden of blindness

Sarah MacIver, OD, FAAO, Waterloo, ON 716A MTCC

Learning Objectives: 1. describe and review diabetic retinopathy 2. apply new strategies in the primary care provider‘s role in management of diabetic retinopathy 3. discuss the Guidelines for the Collaborative Management of Persons with Diabetes Mellitus published by the Eye Health Council of Ontario Description: This session provides an update on best practice patterns for all primary care providers to apply in routine practice to help decrease vision loss and blindness in patients with diabetes. Diabetic retinopathy is the leading cause of blindness in the working age population and, with the growing number of people with diabetes, the burden of vision loss is projected to increase significantly over the next 20 years. In Canada, only 32 per cent of patients with type 2 diabetes follow the Canadian Diabetes Association guideline to get annual eye exams.

Vision loss can be prevented if caught in time but early disease is asymptomatic. Literature shows that recommendations from primary care providers can significantly improve a patient‘s adherence to seeing an eye care provider. The session‘s pearls will include a review of diabetic retinopathy, including the prevalence and the factors for development of vision loss; an identification of strategies for primary care providers to help improve adherence for eye exams in practice; a review of the management that might be required by the primary care provider to help decrease vision loss; and a review of recently published guidelines for the collaborative management of persons with diabetes mellitis, developed by the Eye Health Council of Ontario. A collaborative strategy between primary care and eye care providers is necessary to decrease vision loss in patients with diabetes.

F102568 16:30–17:30

Mifepristone (RU-486): A new drug for Canada, an old drug for Europe Konia Trouton, MD, MPH, CCFP, FCFP, Victoria, BC; Dawn Fowler 714AB MTCC

Learning Objectives: 1. relate the history of mifepristone use worldwide for safe abortion 2. describe the indications, screening, and consent process for mifepristone and misoprostol use in Canada 3. identify common reactions, appropriate follow-up, and management of possible complications Description: Mifepristone and misoprostol have been long awaited in Canada by women‘s health advocates. Available in France since 1988, the United Kingdom since 1991, and the United States since 2000, the mifepristone tablet, combined with misoprostol, allows women and their physicians to terminate unplanned/unwanted pregnancies safely without surgery. In Canada, women who seek pregnancy termination and do not live in major centres face many access barriers. Rural communities might have limited operating room access and/or trained physicians.

Privacy is a concern for many, and travel costs can be prohibitive. Appropriate patient selection and physician training in the use of this new medication might reduce those barriers to access. This workshop will use clinical scenarios after a thorough review of the history and pharmacology of this new medication so that participants will feel confident in offering this option to women.

F102858 16:30–17:00

Measles Gate: An approach to the management associated with a measles exposure in the office setting

Allan Grill, MD, CCFP, Toronto, ON; Lisa Ruddy, RN, Markham, ON 716b MTCC

Learning Objectives: 1. review the clinical signs and symptoms associated with measles and the appropriate tests to confirm the diagnosis 2. outline the infection control steps to prevent exposure to the measles virus, or other airborne infections, to other patients and staff present in the office setting Description: Measles, also known as rubeola, is a viral infection that classically presents with fever and the 3 “Cs”: cough, coryza, and conjunctivitis.

Patients also develop a red maculopapular rash that starts on the face and spreads to the rest of the body. While most people with measles are sick for a few days and recover completely, measles can lead to ear infections, pneumonia, encephalitis, and even death. Measles is a vaccine-preventable disease, and infants are at highest risk until they are immunized with the MMR (measles/mumps/rubella) vaccine at age one. In Canada, due to high immunization rates, cases of measles are rare. The current two-dose regimen administered at ages one year and five years provides 95 per cent protection. However, several factors have contributed to recent outbreaks, including a) patients born after 1970 who only received one immunization against measles, b) patients who refuse to be immunized due to a discredited claim that there is a link between autism and the MMR vaccine, and c) unintended exposures to the virus in countries endemic to measles due to a poor public health infrastructure that lacks universal immunization programs. This presentation will describe a case associated with a measles outbreak in the Greater Toronto area in January 2015. Because the virus is spread easily through respiratory droplets, multiple exposures can occur when an infected patient presents to the busy waiting room of a primary care practitioner‘s office. Participants need to be comfortable responding to such a scenario and this session will provide them with a practical step-by-step approach on how to manage a measles exposure. Topics including close communication with public health, leveraging one‘s electronic medical record (EMR) system to help with contact tracing, and the importance of transparent messaging to all patients and staff will be reviewed. Participants will also be imparted with valuable

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lessons learned, such as the importance of using universal infection control practices to prevent the spread of infections, knowing the immunization status of office staff and providers to ensure protection in the event of a measles outbreak, and being familiar with which laboratory tests to order for a suspected case.

F103867 16:30–17:30

Discussion on Cultural Competence and Acceptance of LGBTQ Patients Within the Family Medicine Community

Noel Garber, Mississauga, ON; Eric Mang, Mississauga, ON 713B MTCC

Learning Objectives: 1. discuss the results of a pilot study done in Mississauga to evaluate cultural competence and acceptance of LGBTQ patients within the family medicine community 2. identify potential strategies for improvement 3. identify opportunities to implement in practice these strategies for improvement Description: In recent years, there is a greater acceptance of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. However, evidence surrounding practices and perceptions among family medicine physicians caring for these patients is not well defined. As such, in early 2015, a small pilot study was conducted to evaluate relevant factors within a sample of family physicians and patients in Mississauga. We will present the results of the study and also offer a venue to identify ways to improve on the major points discussed.

We will use a didactic section at the beginning of the session to show our findings. Then, by way of a guided discussion in an open environment, we aim to develop potential solutions that could effectively be adopted into practice. These could include a blend of existing strategies, such as the safe space framework, and new ideas developed during the session.

FV108671 16:30–17:30

Mainpro+ … A New Look, With New Ways to Learn (4) Mainpro+ … Un nouveau look; de nouvelles façons d‘apprendre (4)

Eric Wong, MD, CCFP – Regional Educator, Ontario Region / Éducateur régional, région de l‘Ontario, London, ON; Scott MacDonald, MD, CCFP (EM), FCFP – Regional Educator, Atlantic Region / Éducateur régional, région de l‘Atlantique, Bedford, NS 803A MTCC

Soyez des nôtres pour une séance d‘information sur Mainpro+ et sur les nouvelles façons d‘obtenir des crédits de DPC pour des activités que vous effectuez au quotidien. De plus, vous pourrez vous renseigner sur les nouveautés concernant le titre de Fellow, l‘agrément et les CCA. Le CMFC s‘est engagé à fournir des programmes de DPC de qualité qui conviennent aux intérêts de ses membres et répondent à leurs besoins en matière d‘apprentissage. Les participants peuvent réclamer un crédit Mainpro-M1 additionnel pour cette séance.

F121370 Methadone for Analgesia: Online training tool for physicians 16:30–17:30 Mike Harlos, MD, CCFP, FCFP, Winnipeg, MB; Cornie Woelk, MD, CCFP, FCFP, Winkler, MB; Dori Seccareccia, MD, CCFP(EM), MSlSc, Toronto, ON 717B MTCC

friday • vendredi

Join us for an informative session on Mainpro+ and the new, practice-centred ways to earn CPD credits for activities you do on a daily basis. Also, hear the latest updates on fellowship, accreditation, and CACs. The CFPC is committed to providing quality CPD to meet your changing interests and learning needs. Participants may claim an additional Mainpro-M1 credit for this session.

Learning Objectives: 1. review the indications and contraindications for using methadone in a cancer setting 2. review mechanisms of action/basic pharmacology, drug interactions, dosing frequency and titrating, adverse effects, routes of administration, safety/disposal, working with patients and families, and when to consult a specialist 3. discover where to access the Methadone for Analgesia Online Training Tool in order to share its content with colleagues Description: Methadone is a valuable analgesic in the palliative care of patients with cancer pain and can improve care outcomes in situations where other analgesia have proven ineffective or intolerable, but as a restricted opioid it can only be prescribed by a physician exempted from prescribing restrictions by his or her province‘s or territory‘s licensing body. Methadone prescribing by palliative care and pain and symptom management teams is limited by the paucity of family doctors able to provide ongoing prescriptions for methadone for analgesia in patients discharged to care in the community. In collaboration with the Canadian Society of Palliative Care Physicians (CSPCP) and leading methadone experts, and using the latest research and clinical best practices, the Canadian Virtual Hospice has created the Methadone for Analgesia Online Training Tool. It provides core competencies in methadone prescribing in palliative care and will lead to standardized, evidence-based care. This project has been endorsed by the CSPCP and the CFPC. Participants will be guided through all the components of this tool: indications and contraindications for using methadone

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE in a cancer setting, mechanisms of action and basic pharmacology, drug interactions, dosing frequency and titrating, adverse effects, routes of administration, safety and disposal, working with patients and families, and when to consult a specialist. Specific considerations for pediatric patients will be addressed. Participants will also learn where to access the tool in order to share the content with colleagues.

F99446 16:30–17:30

FMF Pearls: Clinically relevant research from Family Medicine Innovations in Research and Education Day

Judy Belle Brown, PhD, Londong, ON 712 MTCC

Learning Objectives: 1. synthesize clinically relevant research presented by the CFPC Section of Researchers at Family Medicine Innovations in Research and Education Day 2. stimulate interest in primary care research Description: Please join us for this year‘s “Top 4 Oral Abstracts” session. The CFPC Section of Researchers hosts a pre-conference forum inviting the best research from across Canada. After a rigorous peer-review process determined three dozen or so high-quality projects qualified for oral presentation at Family Medicine Innovations in Research and Education Day, the best of these were chosen to present in this “Best of” session at FMF. The Top 4 clinically relevant research papers of 2015 FMF will be showcased in this special session. Come out to challenge the presenters, share your ideas on the clinical relevance or how to do a better study next time, and cheer on family physicians working to understand how we all can provide the best care for Canadians!

F101839 Sun Protection Behaviours in Primary Care 17:00–17:30 Comportements de protection solaire en soins primaires Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON; Christie Freeman, MD, CCFP, FCFP, Peterborough, ON; Lisa Graves, MD, CCFP, FCFP, Ancaster, ON 718AB MTCC Learning Objectives: 1. discuss and review the evidence for sun protective behaviours in different age groups 2. outline specific strategies to protect infants and children from excess ultraviolet radiation to protect skin health (against cancer, photoaging, etc) 3. integrate sun protective strategies into routine primary care visits through clinical tools and EMR reminders Description: Skin cancer is the most common cancer diagnosis in Canada and numbers diagnosed are expected to more than double in the next 15 years.

Melanoma, basal cell, and squamous cell carcinomas are highly preventable through sun protection behaviours. The importance of educating young children and their parents may lead to lasting benefits on our population as a whole. This workshop will review the evidence-based research on various sun protective behaviours. We will review specific strategies for different age groups and showcase clinical tools for use in primary care. We will suggest tools, such as an information sheet for provider information and an electronic medical record template for office use, and ways to integrate this education using existing clinical management tools (ie, preventative health visits) and patient education materials (eg, bookmark for kids, brochure for patients' caregivers, cellphone app for teens [tweets of 140 characters]).

Objectifs d‘apprentissage : 1. examiner les données liées aux comportements de protection solaire dans différents groupes d‘âges et en discuter 2. souligner des stratégies précises pour protéger les nourrissons et les enfants d‘un excès de rayonnement ultraviolet afin de préserver la santé de la peau (contre le cancer, le photovieillissement, etc.)

3. intégrer les stratégies de protection solaire dans la routine des visites en soins primaires par l'intermédiaire d‘outils cliniques et de rappels dans les DMÉ Description : Le cancer de la peau est le diagnostic de cancer le plus répandu au Canada et l‘on s‘attend à ce que le nombre de diagnostics se multiplie par plus que le double au cours des 15 prochaines années. On peut facilement prévenir le mélanome, le carcinome basocellulaire et le carcinome squameux grâce à des comportements de protection solaire. L‘importance d‘éduquer les jeunes enfants et leurs parents peut entraîner des bienfaits durables dans la population en général. Cet atelier se penche sur la recherche factuelle portant sur divers comportements de protection solaire. Nous examinerons les stratégies spécifiques à différents groupes d‘âge et présenterons les outils

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cliniques à utiliser en soins primaires. Nous proposerons des outils, tels que les feuillets d‘information visant à renseigner les fournisseurs et un modèle à appliquer dans les dossiers médicaux électroniques à l‘usage du cabinet, de même que des façons d‘intégrer cette éducation à l‘aide d‘outils de prise en charge clinique existants (p. ex., visites de santé préventives), et du matériel d‘éducation des patients (p. ex., signets pour les enfants, brochures pour les soignants, appli pour téléphone cellulaire des adolescents (tweets de 140 caractères)).

F102184

Lifestyle Medicine in Obesity Management

Kan Sivalingam, MD, Devon, AB 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. learn a lifestyle scoring method 2. classify obesity and comorbidities 3. devise appropriate therapy/treatment modality in obesity management Description: Seventy to 80 per cent of chronic diseases are related to lifestyle. Lifestyle medicine is a much-needed specialty for primary care physicians. Helping our patients make lifestyle changes to prevent or treat chronic diseases is a pressing problem, with nearly 70 per cent of adults being either overweight or obese. Diet, physical activity, stress management, sleep, alcohol, and smoking are primary areas of interest. Participants will learn how they can use an innovative 20-point scoring system to evaluate and monitor the effects of patients‘ lifestyle changes on their obesity, as assessed using the Edmonton Obesity Staging System and weight, BMI, and body composition scans. The session includes a discussion of how to treat the cause and its comorbidities using a five-path treatment modality of obesity management.

F114793 A 17:45–18:45

Initiating and Intensifying Insulin: Best practices Peter Lin, MD, CCFP, North York, ON 701AB MTCC

Learning Objectives: 1. understand the patient and physician barriers to insulin therapy and how to overcome them 2. recognize potential candidates for insulin therapy and understand how to initiate and adjust basal and mealtime insulin 3. be aware of resources that can help physicians and their patients successfully manage insulin therapy

Participants may claim an additional Mainpro-M1 credit for attending this session

Resident Posters / Affiches des résidents NOVEMBER 13 NOVEMBRE 742

friday • vendredi

Description: For all the recent advances in glucose-lowering therapy, insulin remains the most effective means of controlling blood glucose. While people with type 1 diabetes depend on insulin at the outset, many people with type 2 diabetes can also benefit from insulin at some point. However, research has shown that many physicians perceive insulin management as complicated and delay insulin therapy until they have run out of other options. This slide presentation was designed to bridge this gap, so that physicians can confidently prescribe insulin at the optimal time for the right patients. To this end, the presentation demystifies the components of insulin management and offers a simple, graduated approach that matches patients‘ evolving needs.

Opioid Risk Tool Utilization by the Queen’s Family Health Team in Kingston, Ontario

Jeff Martin, MD, MSc, Kingston, ON; Michael Pham-Nguyen, MD, Kingston, ON; Megan Gao, MD, Kingston, ON; Maaz Kamal, MD, Kingston, ON; Harpal Ubhi, MD, Kingston, ON

Description: Context: The Opioid Risk Tool has Grade B evidence for assessing the suitability of opioids for patients with chronic pain, and some guidelines promote its use to assess patients prior to initiation of prescribing opioids. Objective: In this study, we sought to determine whether prescribers at the Queen’s Family Health Team (QFHT) in Kingston, Ontario were familiar with the Tool. We also wished to learn their attitudes towards the tool and why they have or have not chosen to use it in assessing patients who will be prescribed opioids. Design/Participants: We constructed an online multiple choice and short answer survey for dissemination to all physicians who are permitted to prescribe opioids at the QFHT. The study population consisted of PGY1 and PGY2 resident physicians, staff physicians, and locum physicians, totaling approximately 100 individuals. Intervention: N/A Outcome measures: The proportion of physicians who used the Opioid Risk Tool or some other method to determine safety of initiating opioids. Results: 35 participants responded to the survey. 60% are aware of the existence of an opioid risk tool; approximately 33% felt it would be useful in determining management of chronic, non-cancer pain. Interestingly, about 40% of respondents use a subjective type of assessment

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE or “gestalt” to determine suitability of opioids for management of chronic pain. Conclusion: In conclusion, opioid therapy for patients with chronic pain appears to be very much a subjective decision on the part of the physician, based on past experience and a “gestalt” of the clinical situation faced by him/her. Given the widespread use of opioids for chronic, non-cancer pain, the use of an objective clinical tool would seem imperative to improve the management of chronic pain.

743 Demographic, Socioeconomic, and Geographic Analysis of Frequent Users at Stonechurch Family Health Team

Stanley Lam, MD, Hamilton, ON; Avinash Ramsaroop, MD, Hamilton, ON; Anna Czyrny, MD, Hamilton, ON; Kalyani Vimalesan, MD, Hamilton, ON; Lily Wei, MD, Hamilton, ON; Inge Schabort, MB ChB, CCFP, Hamilton, ON

Description: Context: Studies consistently report that lower socioeconomic status (SES) can negatively impact one’s health. Furthermore, literature suggests that a substantial portion of Canadian healthcare dollars is spent on a small, unique, patient population of frequent visitors. Objective: To characterize frequent users at Stonechurch Family Health Centre (SFHC) by their demographics, geographic location, health visits, socioeconomic status, and economic cost to the healthcare system. Methods: We conducted a quantitative analysis of all weekday OHIP billed patient visits over a two year time period (January 1, 2011 to December 1, 2012) at SFHC. Patient demographics including gender, age, postal code, frequency of visits, and billing codes were extracted from our electronic medical records. Patients were divided into two groups based on the frequency of visits: frequent users (Top 10% of clinic users) and non-frequent users (rest of the population). Using Canadian Census data, we matched each patient’s FSA code to several markers of socioeconomic status. The aforementioned demographic and socioeconomic markers were then compared using paired t-tests and Cohen’s da to identify potential differences. Results: A total of 16,059 patients visited the clinic for a total of 99,630 visits between January 1, 2011 and December 1, 2012. Frequent users were identified as more elderly (average age 48.7 years, p<0.01), and female (67% of frequent users, p<0.01). They incurred significantly higher OHIP billings compared to non-frequent users ($649.83 vs. $166.30 per patient, p<0.01). The Primary Mental Health code (K005A) was billed twice as often, but a Complete Assessment (A003A) was billed 3-times less frequently in the frequent user group. Lastly, frequent users were found to come from neighborhoods with lower average household incomes (p<0.01), lower rates of employment (p<0.01), higher percentage living in subsidized housing (p<0.05) and higher prevalence of low-income status (p<0.01). Conclusion Frequent users at SFHC are more elderly, female, socioeconomically marginalized, and have a higher proportion of visits for mental health concerns. Given the known impacts of poverty and low socioeconomic status on health outcomes, future policies to address these issues may help improve health outcomes and healthcare costs.

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Transitioning Complex Pediatric Patients to Adult Health Care: The family physician perspective Nisha Arora, MD, Markham, ON; Margo Stevenson, MD, Winnipeg, MB; Nisha Arora, MD, Stratford, ON; Christina Grant, MD, FRCPC, Hamilton, ON

Description: Context: In the last 4 decades, there has been a boom of adult patients surviving diseases that were previously lethal in early childhood, such as cystic fibrosis. The importance of a well-coordinated, developmentally appropriate transition from pediatric to adult-oriented healthcare is compelling. Family physicians are uniquely situated to maintain continuity of care throughout the lifespan; however, most of the research on transitioning adolescent patients has focused on pediatric and internist perspectives. Objective: To examine the family physician perspective on barriers, available resources, and role in relation to subspecialists when transitioning youth with childhood-onset disorders from pediatric to adult-oriented care in Canada. Design: This is an observational, descriptive survey study. Participants: A convenience sample of >200 family physicians currently practicing in Sault Ste. Marie, Ontario and Hamilton, Ontario. Instrument: A 10-point Likert scale survey to rate barriers and beliefs, with opportunity for free-form input. Survey was derived from previous studies and modified with informal family physician input. Outcome Measures: The primary outcome measure is the percentage of family physicians experiencing barriers. Secondary outcomes are beliefs and practice patterns as it relates to transitional care, and the degree to which proposed barriers limit the physician’s ability to provide transitional care. This is determined by mean Likert ratings and standard deviations. Multivariable regression analyses assess associations between physician characteristics and perceived barriers, beliefs, and practice patterns. Results: Commonly identified barriers by subspecialists in the existing literature include: insufficient knowledge of “pediatric” conditions to care for these patients as adults; managing family involvement; and difficulty accessing superspecialists. Conclusions: We anticipate that our results will inform Canadian physicians of the perceived barriers that family physicians face, which we expect will be different from the subspecialist perspective. This may potentially lead to interventions addressing these barriers, help delineate the roles of different healthcare providers, and make better use of family physicians as an integral part of the transitional healthcare team. We hope that the challenges faced by adolescents who are transitioning to the adult system may be better addressed by bringing family physicians into the centre of discussions on healthcare transition.

746 Improving Care for Complex Patients in Primary Care Through Implementing Coordinated Care Plans in the Electronic Medical Record: A quality improvement project

Hana Thomas, MD, Toronto, ON; Caroline Jeon, MD, Toronto, ON; Andrew D. Pinto, MD, CCFP, FRCPC, Toronto, ON

Description: Context: Coordination of care for complex patients in primary care has been demonstrated to improve patient outcomes and reduce overall health-care expenditure. Increasingly, many primary care centers in North America are adopting a complex care management team-based approach to streamline care for these patients. However, significant issues remain around identifying and scaling-up any model of care.

Objective: To increase the number of complex patients in each of two St. Michael’s Family Health Team physician practices who have a simple, up-to-date coordinated care plan in place on their electronic medical record (EMR). Design: A quality improvement project consisting of two separate Plan-Do-Study-Act (PDSA) cycles conducted throughout a three month period. Target Population: Complex patients were identified based on the number of visits with their primary care physician (PCP) within a 12 month period and based on the presence of at least 3 out of 43 chronic conditions consisting of the Charlson’s Comorbidity Index conditions, listed on the patient’s medical record.

Intervention: PDSA #1: Identify the top 10% of complex patients in two separate physician practices using a standardized EMR query. PDSA #2: Meet with each PCP and other allied healthcare professionals involved in the patient’s care to design a complex care plan (CCP) for five complex patients in each practice. Process Evaluation: At the end of the second PDSA, at least five complex patients in two physician practices will have a patient-oriented needs assessment and care plan and an up-to-date patient information and summary of medical issues in place on their respective EMRs. Findings: From each of the two practices examined, a total of 20 patients were identified as complex. fmf.cfpc.ca

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The top five from each practice were selected and a CCP was devised and placed in their respective EMRs. Conclusions: The identification of patients with complex care needs in an urban primary care practice and the implementation of a coordinated care plan is both relevant and feasible. Such care plans for complex patients may improve patient outcomes. Further research is needed to determine the sustainability, scalability and to measure patient outcomes resulting from a care coordination plan.

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Improving Outcomes for Pregnant Women in Thorncliffe Park via a Prenatal Exercise and Education Program

Emilie Boucher, MD, Toronto, ON; Eileen Ten Cate, MD; Karen Fleming, MD, MSc, CCFP; Emmanuelle Britton, MD CM, CCFP; Maureen Gans, MEd; Nawal Al-Busaidi

Description: Context: For women in Thorncliffe Park, the main health care gaps identified are accessing services in the areas of reproductive and sexual health, pre-natal and post-partum care, chronic disease (particularly diabetes and cardiovascular disease) and mental health.

Ontario’s Better Outcomes Registry and Network data demonstrates that compared to Toronto as a whole, within the Thorncliffe Park community, there is a lack of access to early pre-natal care. Additionally, there is an increased risk of gestational diabetes mellitus, intrauterine growth restriction and excessive weight gain during pregnancy. By working with the Thorncliffe Neighbourhood Office, we hope to demonstrate how exercise and prenatal education improves health for women and their newborns. Objectives: 1. To determine if participation in this program a. increases women’s knowledge about healthy lifestyle in pregnancy. b. improves mother and newborn health outcomes as measured by rates of gestational diabetes mellitus, weight gain, birth weight, mode of delivery, breastfeeding rates and other medical complications compared to Ontario’s Better Outcomes Registry and Network data. c. improves mood and decreases social isolation. Design and intervention: Our goal is to recruit 45 pregnant women in the Thorncliffe Park community who will participate in 11 sessions: 10 in person (intake session, 8 exercise and education sessions and a debrief session) and 1 post-delivery telephone survey. Education will be based on national recommendations for a healthy pregnancy including nutrition, exercise and mental health. After each education session, participants will engage in low-impact physical activity In keeping with national guidelines. Participants will also be encouraged to exercise an additional 2-3 times a week outside of the program. Descriptive statistics and Fisher’s Exact test will be conducted on study data. Analysis of Variance will examine change in knowledge scores before and after participation in the education program. Results and conclusion: Collection is currently ongoing for this research project and will be complete by October 2015.

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Relationship Between Depression, Anxiety, and Social Support in Older Family Practice Patients Xiao (Jenny) Xiong Yu, Toronto, ON; Bonnie Au, MSc, Toronto, ON; Katherine Stead, Toronto, ON; Rahul Jain, MD, CCFP, Toronto, ON; Liisa Jaakkimainen, MD, MSc, CCFP, Toronto, ON; Jocelyn Charles, MD, MScCH, CCFP, Toronto, ON

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Description: Context: The population of Canada is aging, with those over 65 expected to double over the next 25 years. Older patients who access healthcare frequently may be more likely to have depression, anxiety, and low social support. Depression and anxiety can be difficult to identify in older patients, and knowing which older patients are at increased risk for depression and anxiety will help family doctors identify these patients. Social support is an important determinant of health among older patients, and whether or not the association between social support and depression or anxiety differs based on frequency of visits to the family doctor is not known.

Objective: To determine the relationships between depression and social support and between anxiety and social support among older patients of a family practice based on the frequency of their visits. Design: Cross-sectional descriptive study. Participants: Adults aged 65 years and older who are patients of the Sunnybrook Academic Family Health Team in Toronto, Ontario, Canada. We studied the top 5% and bottom 5% of users as determined by frequency of visits to the family doctor between July 1, 2013 to June 30, 2014.

Instrument: Structured telephone-based questionnaire. Outcome measures: The Geriatric Depression Scale (GDS), Generalized Anxiety Disorder 7-item (GAD-7), and OARS Social Support Scale were performed on all patients. Spearman’s correlation was used to assess the relationship between the variables. Results: We performed 39 interviews on 19 high frequency and 20 low frequency users. The association between depression and social support was -0.41641 (p = 0.0762) among high frequency users and -0.38717 (p = 0.1015) among low frequency users. The association between anxiety and social support was -0.45631 (p = 0.0496) among high frequency users and -0.07522 (p = 0.7596) among low frequency users. Conclusions: Among older patients who visit their family doctor frequently, social support may be a protective factor for anxiety, with less anxiety when there is higher social support.

Therefore, screening for low social support during office visits with older patients who visit frequently may increase the recognition of anxiety disorders among these patients. Keywords: Geriatrics, primary care, depression, anxiety, social support.

Exploring Barriers to Measurement of Body Mass Index and Abdominal Circumference in Primary Care Lucy Horvat, MD, MSc, Acton, ON; Graham Swanson, MD, MSc, CCFP, Burlington, ON

Description: Context: The prevalence of obesity in Canada is rising. Multiple Canadian Clinical Practice Guidelines recommend measurement of body mass index (BMI) and abdominal circumference in overweight, obese, diabetic and or hypertensive patients to assess obesityrelated health risks. Despite these recommendations, uptake in the primary care setting has been variable. Objectives: To evaluate performance in a community primary care setting with respect to measurement of BMI and abdominal circumference and to explore physician attitudes and identify perceived barriers to use in practice. Study Design & Methods: A mixed-methods study involving a cross-sectional analysis of electronic medical records and a survey of family physicians. Survey was administered online via SurveyGizmo and family physicians involved in postgraduate training at the McMaster Halton distributed medical education site

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE were invited to participate. The study was submitted for review by the Hamilton Integrated Research Ethics Board. Results: Measurement of BMI was higher than that of abdominal circumference (45 percent (%) compared with 2%). Twelve of 18 physicians (66%) invited to complete the questionnaire responded. Most physicians were aware of the clinical practice guidelines’ recommendations to measure BMI (92%) and abdominal circumference (75%). However, only 33% felt BMI measurement was important compared with 50% for abdominal circumference. The greatest perceived barrier to BMI measurement was the perception of limited value added (27%). Physicians reported more perceived barriers to measurement of abdominal circumference including: patient resistance (63%), time constraints (55%), limited value added (45%) and uncertainty with abdominal circumference measurement technique (36%). Conclusion: Despite multiple clinical practice guidelines recommending the measurement of BMI and abdominal circumference in primary care, adherence to these guidelines is poor. Perceived barriers of lack of time, patient resistance and limited value added need to be addressed if compliance is to improve.

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Student Posters / Affiches des étudiants NOVEMBER 13 NOVEMBRE 724

Family Physicians’ Perceived Patient Satisfaction and Their Actual Satisfaction

Fariha Eshrat, Riyadh, Saudi Arabia, Baraa Alghalyini, MD, CCFP, MHSc, Riyadh, KSA; Emad Masuadi, PhD, Riyadh, KSA; Mazen Ferwana, MD, ABFM, JBFM, PhD, Riyadh, KSA

Description: Introduction Literature has shown that patient doctor interaction has significant impact on the patient’s satisfaction, and thus, their compliance. Therefore, effective doctor-patient communication is the bedrock for better patient health outcome. Consequently, the majority of malpractice allegations arise from communication errors. Objectives · Measure satisfaction of patients managed by family physicians in Saudi Arabia. · Measure the family physicians’ self-perception of the quality of their patient care · Identify any gaps between the prior objectives, and the source of the gap Methodology A cross-sectional study, using questionnaires administered after a doctor-patient clinical interaction. Corresponding questionnaires were given to both the doctor and the patients. Results Both stake holders are satisfied with the appointment interactions, and there is no gap in between. Most patients reported high satisfaction with consultation time, high rust in doctor’s diagnoses, and approachability in discussing concerns. Lack of continuity of care, adequate channels of communication with the doctors were the most common negative scores.

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Impact of Comorbidities and Medications on Frequency of Primary Care Visits Among Older Patients

Tina Hu, MSc, Toronto, ON; Neil D. Dattani, MD; Bonnie Au, MSc; Leo Xu; Don Melady, MD; Liisa Jaakkimainen, MD; Rahul Jain, MD; Jocelyn Charles, MD

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Variations Among Spirometry Interpretation Algorithms: A push toward standardization

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Description: Context: The population of Canada is aging, with those over 65 expected to double over the next 25 years. In 2055 approximately one quarter of Canadians will be over 65. Data has suggested that older patients are more likely to access primary care and visit their family physician more often compared to younger patients. By understanding specific factors that influence the frequency of visits older patients make to their primary care physician, improvements can be made to provide more efficient and effective care for this age group. Objective: To determine if comorbidities and high risk medications impact the frequency of visits to a family physician among older patients. Design: Retrospective chart review. Participants: Among patients aged 65 and older seen at the Sunnybrook Academic Family Health Team between July 1, 2013 to June 30, 2014, the 5% that visited the family practice most frequently and the 5% that visited the family practice least frequently were selected for the study (N = 264). Instrument: Family practice electronic charts. Outcome measures: Charlson Comorbidity Index and age-adjusted Charlson Comorbidity Index were used to assess comorbidities. Beers criteria and the Anticholinergic Risk Scale (ARS) were used to identify high risk medications. We also abstracted the total number of medications patients were taking. Results: Charlson Comorbidity Index and age-adjusted Charlson comorbidity index were not associated with frequency of visits among older patients (p > 0.05). Total number of medications was significantly related to frequency of visits: for a one unit increase in total number of medications, the odds of being a high frequency user of primary healthcare services increased by a factor of 1.54 (p < 0.001). The number of Beers criteria medications and ARS score did not significantly impact frequency of visits. Conclusions: In general, total number of medications was a key factor among older patients in determining frequency of visits to family care physicians. Tools such as the Charlson Comorbidity Index, Beers criteria, and ARS were not able to independently predict the frequency of visits, indicating that predicting frequency is likely complex and there are multiple factors which lead to family physician visits.

Florence Mok, Mississauga, ON; Amy Liao: Anthony D’Urzo, MD, CCFP, Toronto, ON

Description: Context: Asthma and COPD are two of the most common respiratory illnesses encountered in primary care. Though patients often present with similar symptoms, it is important to distinguish between the two diseases because their pathophysiology and management is very different. Simple spirometry is an objective pulmonary function test that can support a diagnosis of asthma or COPD, but recent evidence has demonstrated that patients with moderate to very severe COPD also meet spirometric criteria for asthma diagnosis. Spirometry interpretation algorithms (SIA) should conform to diagnostic guidelines while acknowledging this overlap and prompting the clinician to consider further clinical assessment where such an overlap exists. Aim: To determine the variations in SIA that exist in the published literature and online sources. Method: Medline, Embase, and mainstream search engines were used to identify all SIA-related material dating back to 1990. Keywords used were “spirometry”, “algorithm”, “algorism”, and “algorhythm”. Results: 17 out of 27 SIA are unable to serve well as stand-alone documents. 24 SIA lack a logic string to postbronchodilator FEV1/FVC ratio, potentially impeding COPD diagnosis. 10 SIA rely solely on post-bronchodilator improvement to definitively diagnose asthma. 23 SIA lack a prompt for bronchodilator challenge when FEV1/FVC is normal. 4 SIA unnecessarily recommend DLCO testing to confirm COPD diagnosis. Conclusion: 25 out of 27 SIA feature variations that may lead to disease misclassification. Further studies are needed to confirm whether or not these results have a real impact on disease diagnosis and treatment decisions. This study points to the need for minimizing SIA variability and the development of a standardized approach to asthma and COPD diagnosis.

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How Function and Social Support Predict Frequency of Family Practice Visits Among Older Patients

Xiao Xiong Yu, Richmond Hill, ON; Neil D. Dattani; Bonnie Au; Katherine L. Stead; Rahul Jain; Liisa Jaakkimainen; Jocelyn Charles

Description: Context: The population of Canada is aging, with those over 65 expected to double over the next 25 years. In 2055 approximately one quarter of Canadians will be over 65. Improvements in primary care delivery are necessary to more efficiently care for our aging population.

Current literature shows a gap in understanding how level of function and social support influence the frequency of visits to the family doctor.

Objective: To determine the relationship between level of function, level of social support, and frequency of visits to an urban academic family health team by elderly patients. Design: Cross-sectional descriptive study. Participants: Adults aged 65 years and older who are patients of the Sunnybrook Academic Family Health Team in Toronto, Ontario, Canada. We studied the top 5% and bottom 5% of users as determined by frequency of visits to the family doctor between July 1, 2013 to June 30, 2014. Instrument: Structured telephone-based questionnaire.

Outcome measures: The Duke Social Support and Stress Scale (DUSOCS), the Older Americans Resources and Services (OARS) social support subscale, and OARS functional assessment were performed on all patients. T-test was performed to compare high frequency and low frequency users of the family practice. Spearman’s correlation was performed to identify correlations between social support and level of function. Results: We performed 39 interviews with 19 high frequency and 20 low frequency users. The low frequency group had significantly higher level of function compared to the high frequency group (p = 0.02). There was no difference in social support using either the DUSOCS or OARS scores between the two groups. The only significant correlation was a positive correlation between stress and level of function in the high frequency group (p = 0.02). Conclusions: Low level of function was associated with increased frequency of visits, however low social support was not. This indicates that older patients may be more likely to visit their family doctor for physical complaints than for emotional complaints. Given the increased risk of depression and isolation among older patients, family doctors should more proactively elicit emotional concerns from these patients.

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Barriers to and Facilitators of Medication Adherence From the Perspective of Inmates

Karolina Kowalewski, BHSc, MSc, Calgary, AB; Lauren Cuthbertson, BESc, Calgary, AB; Jennifer Edge, BHSc, MSc, Calgary, AB; Keith Courtney, DO, CCHP, Calgary, AB

Description: Context: Effective medication delivery to inmates within correctional facilities is essential for managing symptoms, preventing relapse, slowing disease progression, and enabling recovery. Despite the importance of medications they are often refused by inmates. A number of studies have explored factors affecting medication adherence in the general population, however, few studies have explored this issue in the context of the prison-setting. Our study explores inmates’ views of the barriers to and facilitators of medication adherence at the Calgary Remand Centre (CRC). Objective: To explore the individual and prison-setting factors that affect medication adherence from the perspective of inmates at CRC and to develop recommendations for medication administration in correctional facilities. Design: A mixed methods study using clinical records, structured questionnaires and qualitative interviews were used. Participants: CRC accommodates 704 remanded male and female inmates awaiting trial, transfer to appropriate provincial and federal institutions, and sentence inmates with further charges. All inmates at CRC are over 18 years and the majority are male. The eligibility criteria for our study include: inmates at CRC who are currently receiving prescription medications from the healthcare staff at the facility, and inmates that have had 1 or more incidents of medication non-adherence since their admission to CRC. Instrument: The instrument gathers information on participant demographics, general health information, medication information, prison-setting barriers/facilitators, and individual barriers/facilitators to medication adherence. Outcome Measure: The primary outcome measures are individual and institutional-level determinants of medication adherence. Findings: At the individual level, medication adherence is influenced by personal insight into disease and medication management, inmate social support, and medication side effects. At the institutional level, the rigid inmate schedule and the attitudes of healthcare providers towards inmates also affect medication adherence at the CRC. This combination of factors perpetuates the knowledge gap between physicians and vulnerable patients in the prison-setting, negatively affecting medication adherence. Conclusions: The findings of this study inform recommendations to improve disease management at the CRC and other correctional facilities. The results can be applied to other vulnerable populations outside of the prison-setting and could inform physicians working with similar populations in the community.

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Chronic Insomnia: Time to change our behaviour?

Laila Jumma, Calgary, AB

Description: Background: Chronic insomnia affects nearly 3.3 million Canadians. It is associated with increasing age. In Canada, the use of sleeping medication has nearly doubled from 2.9 million prescriptions to five million in 2011. During family medicine clerkship a dilemma presented when a 67-year-old woman asked my preceptor (her family doctor) to increase or change her sleeping medication- after 7 years of use, it was no longer effective. My preceptor was reluctant to change her medication, but the patient was adamant. My research question was-what is the evidence for non-pharmacological treatment of chronic insomnia? Objective: Participants will be able to evaluate the effectiveness of cognitive behavioural therapy (CBT) for chronic insomnia. Methods: My PICO question examined patients (>65 years) with chronic insomnia and compared use of CBT with hypnotic use for sleep improvement. I limited my PubMed search to randomized controlled trials, age (>65 years), published in the last ten years. Studies were restricted to similar patients encountered in family medicine. Study validity was appraised using JAMA evidence to include factors such as blinding, and concealment of patient allocation. Results: Over a thousand studies, narrowed to three randomized controlled trials (n=209, 70, 46). The first RCT concluded that at 3, 6, and 12 months, patients treated with CBT (6-8 sessions) showed overall improvement in their Pittsburg sleep quality index scores, with reduced hypnotic drug use-33% report no use by 6 months. The second study determined that CBT allowed significant sleep diary improvement and reduced the time for patients to fall asleep.

The third study demonstrated that zopiclone effects did not differ from placebo. In patients receiving CBT, their sleep efficiency improved from 81.4% to 90.1% post treatment. In contrast, patients’ sleep efficiency decreased, when taking zopiclone alone. Conclusion: CBT is superior to hypnotic use in the treatment of chronic insomnia. As family doctors increasingly have access to behavioural consultants in the community, CBT should be considered as a viable option in the management of chronic insomnia.

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Community Doctor Preferences for Hospital Discharge Medication Information Jackie Mann, Drumheller, AB; Echo Enns; MD, CCFP, Calgary, AB

Description: Objective: Learners will gain insight into how family doctors interpret the clarity, organization and usefulness of medication information found in hospitalists’ discharge summaries and improvements they suggest. Background: Transition from hospital to home represents a vulnerable time for patient safety, particularly surrounding medication changes. As part of the hand-off to primary care, medication changed in hospital is disseminated to patients’ receiving family doctors in the discharge summary, a one-way communication varying by author. As the Calgary Health Region works to implement a Required Organizational Practice (Accreditation Canada) to improve safety, we bring community doctors’ insight into the process. Until now, hospitalists have never asked for feedback on the medication information relayed through these work intensive documents. QI Methods: We invited community family doctors whose patients are discharged from the Peter Lougheed Centre Hospital (PLC) in Calgary to evaluate discharge summaries they recently received. 6 doctors participated and 23 discharge summaries were analysed. Participants were asked to rate and comment on the clarity, organization, and completeness of the medication information. We asked how they determine what home medications a patient should take from the discharge summary and what improvements could be made.

We presented the results to hospitalists who had authored the discharge summaries and were eager to learn the subsequent recommendations. Results: All community doctors found without home meds listed, the overall use of the discharge summary was reduced. 41% of the time, some home medications were not represented. Only 55% of the time, community doctors were confident they knew what changes to home medications were made in hospital. Why a dose or schedule of a home medication changed was clear 55% of the time and 83% of interviewed doctors wanted the reasoning behind changes. Perceived medication errors totalled a whopping 54. 69% of medication information evaluated was considered “organized” but there was no consensus how it should be structured. Conclusion: In addition to technological builds suggested, hospitalists were recommended to include 1) a full list of home medications 2) rationale behind medication changes to ensure it is clear what was known and what was intended.

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Putting Communities First: The SHINE model for interdisciplinary, service-oriented medical education

Jennifer Edge, BHSc, MSc, Calgary, AB; Tammy Nighswander, MScPT, Calgary, AB; Karolina Kowalewski, MSc, Calgary, AB; Lauren Cuthbertson, Calgary, AB

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Description: Context: The CanMEDS Framework emphasizes leadership and advocacy as core competencies of the well-rounded physician.

However, Canadian medical students often fail to receive adequate training in these crucial areas. Additionally, preventative health, inter-professional collaboration and “systems thinking” are often lacking in traditional medical education. The Students for Health Innovation and Education (SHINE) program at the University of Calgary was created to address these gaps. The SHINE model promotes interdisciplinary collaboration and unites the fields of medicine, population health and social policy by embedding students in service-oriented, longitudinal partnerships with community-based organizations (CBOs). Objective: To provide medical students with hands-on, longitudinal training in community development, leadership, and interdisciplinary collaboration. Design: Four students conducted mixed-methods research on inmate health at the Calgary Remand Centre in collaboration with site staff. Seven students partnered with the YMCA to design, implement and evaluate a Youth Wellness Program. All students organized monthly journal clubs and events featuring prominent leaders (e.g., in Prison and Aboriginal Health). Participants: 24 self-selected medical, public health, nutrition, and social work students were enrolled in the first two iterations of the SHINE program. Instrument: Survey evaluations were conducted at the end of each service cycle to assess the program’s impact on students’ professional development.

Outcome Measures: Primary outcome measures addressed SHINE’s impact on: 1) development of the CanMEDS Roles, 2) skills and knowledge acquisition to improve the health of vulnerable populations, and 3) professional development and career planning.

Results: SHINE participants reported development across the majority of the CanMEDS Roles. On a 7-point Likert scale, the majority of students reported that they “Agreed”/“Strongly Agreed” that the program enhanced their skills and/or knowledge of working with vulnerable populations that would not otherwise be provided in the traditional curriculum. The majority also “Agreed”/“Strongly Agreed” that their involvement in SHINE influenced how they wanted to practice medicine in the future. Conclusions: The SHINE model demonstrates that student engagement in service-oriented, longitudinal community partnerships can advance individual development in each of the CanMEDS roles while supporting CBOs in achieving their goals. Similar models could be considered valuable complements to traditional medical curricula.

Disability Profiles in French-Canadians With Affective Symptomatology Surveyed in Primary Care Settings

Nina Nguyen, MD candidate, Montreal, QC; Pasquale Roberge, PhD, Sherbrooke, QC; Mathieu Philibert, PhD, Montreal, QC; Louise Fournier, PhD, Montreal, QC; Arnaud Duhoux, PhD, Montreal, QC; Annie Benoît, BA, Sherbrooke, QC

Description: Context: Depression is associated with significant disability, but less is known about the contribution of anxiety symptoms to disability. Objective: To examine the disability profiles pertaining to depressive and/or anxious symptomatology (DAS). Design: Data were drawn from the Dialogue Project, an observational study conducted in 64 primary care clinics (Quebec, Canada). Participants: The sample of 14,833 adults was recruited in primary care clinics’ waiting rooms when consulting a general practitioner for oneself.

Instruments: The Hospital Anxiety and Depression Scale (HADS) was used to assess DAS. The World Health Organization Disability Schedule (WHODAS; short 12-item version) was used to assess disability in six domains: mobility, life activities, cognition, social participation, self-care and getting along. Outcome Measures: Respondents were divided in four groups according to their HADS score: anxious subjects (n=4667), depressive subjects (n=2304), anxious-depressive subjects (n=1785) and control subjects (n=9543).

Results: Preliminary results indicate that depressive subjects, compared to anxious subjects, presented higher levels of disability for all

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE six domains, and anxious-depressive subjects presented the worst loss of functionality. For the social participation domain, multiple logistic regression models showed that anxious subjects (OR = 4,10; CI=3,72-4,52), depressive subjects (OR = 7,50; CI=5,95-9,46) and anxiousdepressive subjects (OR= 18,62; CI=15,76-22,01) were more likely to present disability than control subjects. Conclusions: Depressive symptoms were associated with more disability than anxiety, but comorbid depressive-anxious symptomatology significantly increased disability levels in all domains. Anxious symptoms are also associated with a higher level of disability than the absence of DAS. Recognizing that any type of DAS likely causes disability will further the efforts to improve diagnosis and treatment of common mental disorders in primary care.

Posters / Affiches NOVEMBER 13 NOVEMBRE 710

Procedural Skills During Residency: Introduction of a procedure clinic to improve technical competencies Jennifer Sy, MD, CCFP, Toronto, ON; Jessica Roy MD, CCFP, Toronto, ON; Diana Toubassi, MD, CCFP

Description: The Canadian College of Family Physicians expects residents to be competent in several procedural skills by the end of their residencies, but there is currently no consensus on the best method to teach these skills. This study aimed at quantifying residents’ exposure to standard office procedures, their confidence levels regarding execution, and whether introducing a dedicated Procedure Clinic to the residency curriculum would increase both these metrics. All first year Family Medicine residents at the Toronto Western Family Health Team were surveyed regarding their exposure to standard office procedures, as well as their confidence level in the execution of those procedures. A bi-monthly Procedure Clinic was then created for residents, with residents who participated in this clinic ultimately being compared to controls, who did not, on these same measures. Residents who participated in the Procedure Clinic were exposed to significantly more procedures than residents who did not, controlling for level of training (mean 6.6 vs 2.2, p=0.005). Furthermore, residents who participated in the Procedure Clinic felt generally more confident in their ability to perform procedures than residents who did not (P<0.05). Therefore, creating a dedicated Procedure Clinic increases residents’ exposure to procedural skills training, as well as subjective confidence in executing these skills.

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Use of Public Health and Afrocentric Methods to Increase Cancer Screening in an Immigrant Population

Onyenyechukwu Nnorom, MD, CCFP, MPH, FRCPC, Toronto, ON; Liben Gebremikael, MA, Toronto, ON; Nan Shi, PA, Toronto, ON; Abel Gebreyesus, MHI, Toronto, ON

Description: Context: Numerous studies have demonstrated that immigrant populations are generally less likely to undergo cancer screening, compared to the Canadian-born population. TAIBU Community Health Centre serves the Black community in the Greater Toronto Area as well as the local, largely immigrant, populations of Scarborough. TAIBU’s cancer screening rates were previously low but are improving steadily over time, by applying public health frameworks and integrating them with our organizational values (mainly Afrocentric) in order to improve our internal screening practices and ultimately, community outcomes. Objective: To increase breast, cervical and colorectal cancer screening rates at TAIBU CHC. Design: Quality Improvement Planning & Evaluation Participants: Patients at TAIBU CHC Intervention: A comprehensive quality improvement strategy was used to increase screening rates: (1) Establishment of a staff Preventive Taskforce; (2) Assessment of barriers and promising practices including: provider audits, education, a patient call-back system, identification of community partners to reduce transportation costs, informing patients of the availability of same-gender provider options for screening procedures; (3) Establishment of a Quality Improvement approach using the Plan-Do-Study-Act framework; (4) Provider and patient engagement using an Afrocentric “collective village” values-based approach. Outcome Measures: Breast, cervical and colorectal cancer screening indicators Results: Cancer screening indicators at TAIBU CHC were relatively low in the 2012/13 fiscal year (Breast: 24.84%; Cervical: 56.01%; Colorectal: 24.57%) and increased substantially in the 2014/15 fiscal year to 63.05%; 57.25%; and 64.79, respectively. Although CHC indicators are based on services offered, a cross-sectional chart review was also conducted to assess completion rates. Among the patients offered breast, cervical and colorectal cancer screening, 90.10%, 96.75% and 83.64% completed the screening tests, respectively. Conclusions: By establishing a Preventive Taskforce of TAIBU CHC staff who designed a comprehensive, evidence-informed cancer screening initiative grounded in organizational cultural values, we were able to almost triple breast and colorectal screening rates in an otherwise under-screened immigrant population.

712 Dying to Learn: A scoping review of breast and cervical cancer studies focusing on African-Canadian women

Onyenyechukwu Nnorom, MD, CCFP, MPH, FRCPC, Toronto, ON; Nakia K. Lee-Foon, MHSc, Toronto, ON; Ankur Jain, MD, Toronto, ON; Onye Nnorom, MD, CCFP, MPH, FRCPC, Toronto, ON; Carolyn P. Ziegler, MA, MISt, Toronto, ON; Fran E. Scott, MD, CCFP, FRCPC, MSc, Hamilton, ON; Aisha K. Lofters, MD, PhD, CCFP, Toronto, ON

Description: Context: Cancer is the leading cause of death in Canada. Although the Canadian Cancer Registry does not collect information on race or ethnicity, international studies have demonstrated that African-American women have a 41% higher breast cancer death rate, and are nearly twice as likely to die from cervical cancer as white women, and that UK Black women had poorer breast cancer survival rates (aged 15-64 years) and were at higher risk of cervical cancer (65 years and over) compared to their white counterparts. In Canada, several studies have demonstrated that immigrant women are less likely to be up to date on cancer screening than Canadian-born residents. African Canadian women may be under-screened for cervical and breast cancer and may be predisposed to worse outcomes, however such information can be difficult to find. Objective: To identify common themes and gaps in the literature regarding cervical and breast cancer prevention and management in African Canadian women. Design: Scoping Review Participants: N/A Intervention: We searched Medline, Embase, EBM Reviews, CINAHL, PsycINFO, and Scopus databases (2003-2013), and conducted a grey literature search of Canadian cancer and public health agencies, community health websites and organizations dedicated to black healthcare. Relevant studies were selected, data was charted, and themes were extracted. Outcome measures: Themes were mapped based on pre-set criteria: screening; incidence; prevalence; mortality; barriers; promising practices; other Findings: A total of 1125 abstracts and 13 grey papers were identified through database and website searches; 19 studies were selected for detailed review. Among these, 12 matched our inclusion criteria. Themes: most studies focused fmf.cfpc.ca

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on cancer screening and generally showed lower screening rates for breast and cervical cancer among African-Canadian women.

Further, most studies identified a lack of culturally specific programs and initiatives, inadequate awareness, low socio-economic status and unfamiliarity with services as barriers to seeking screening. Gaps: none of the papers reported incidence or mortality rates specific to the African-Canadian population. Conclusion: There is a paucity of health research on breast and cervical cancer specific to African-Canadian women. This review can provide guidance for future research which may improve health outcomes in this population.

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Bad Behaviour: Why are family physicians disciplined by professional colleges in Canada?

Sabrina Akhtar, MD, CCFP, MHSc, Toronto, ON

Cancelled

Description: Background: Family physicians are uniquely positioned amongst doctors to provide continuing care through repeated contacts as they build core patient-physician relationships. It is unclear whether family physicians are better able than other doctors to recognize when their own personal issues interfere with effective care, and are more cognizant of the power imbalance between doctors and patients and the potential for abuse of this power. If family physicians have an enhanced understanding and appreciation of the complexity of the patient-physician relationship, they might be expected to better avoid disciplinary action for offenses committed against patients as compared to non-family physicians. Aim: The aim of this study was to compare the characteristics of family physicians disciplined in Canada, and the frequency and nature of their offences committed against patients for the fourteen years from 2000 through 2014 to other physicians disciplined during that timeframe. Methods: Utilizing a retrospective cohort design, we constructed a database of all physicians disciplined by provincial licensing authorities in Canada for the ten years from 2000 through 2014. Demographic variables and information on type of misconduct violation and penalty imposed were also collected for each physician disciplined. We compared family physicians to non-family physicians for the various outcomes.Results:Results will be reported as the percentage of family physicians of total physicians disciplined in Canada in the fourteen years from 2000 through 2014. Of those disciplined family physicians, we will report the proportion of women compared to the national cohort, and whether a higher or lower proportion of family physicians were disciplined for sexual misconduct and unprofessional conduct towards patients. We will report the result of family physicians as having either greater or lower risk of having disciplinary penalties in categories of offenses in comparison to other physicians.Conclusion: Family physicians differ from non-family physician physicians in the prevalence of misconduct against patients. Understanding the ethical pitfalls encountered by family physicians in longitudinal patient-physician relationships is a step towards decreasing this medical misconduct. Initiatives to improve family physicians’ appreciation of their unique role in the centrally important patient-physician relationship need to be conducted and systematically evaluated.

Continuity of Care at NYGH: Taking stock and planning for the future

Allyson Merbaum, MD, CCFP, FCFP, Toronto, ON; Vanessa Rambihar, MD, CCFP; Rebecca Stoller, MD, CCFP; David Eisen, MD, CCFP, FCFP; Risa Freeman, MD, MEd, CCFP, FCFP

Description: Context: The College of Family Physicians of Canada (CFPC) identified “Continuity of education and patient care” as a key component of the Triple C Curriculum for Family Medicine residency training in 2011. The Family Medicine Postgraduate Program at North York General Hospital (NYGH), a large suburban community teaching hospital, has provided a preceptor-based training model since its inception in 1980. This model allows for continuity of education (supervision, learning environment, and curriculum) and for continuity of patient care whereby learners work with their preceptors to provide care in an immersion model. With the increase in distributed models of postgraduate training, it is imperative that we examine the factors that contribute to our residents’ experience and their perceptions regarding the provision of continuity of care. Objective: To explore the factors that influence a resident’s perception regarding the provision of continuity of care during their training program. Design: An extensive literature review and stakeholder consultations led to the development of an innovative model for the exploration of factors contributing to the resident’s understanding of continuity of care. This model, the SRP, examines the issues that influence the learner’s perception of their continuity of care experience through the lens of the System, the Resident’s responsibilities, and the Preceptor. The SRP was applied to the existing training program at NYGH in order to identify key areas for further exploration. Results: The application of the SRP revealed many important factors for consideration at our site in our ongoing effort to enhance the continuity of care experience in our training program. Conclusions: As one of the pillars of the Triple C Curriculum, and central to the practice of Family Medicine, it is imperative that all training programs address and explore the continuity of care experience provided for their learners. The application of the SRP model provides a new and innovative way of looking at the resident’s experience in this area. Future research will examine holistic interventions at each of the SRP levels to enhance the continuity of care experience and to determine how best to inculcate this construct into the identity of our future family physicians.

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Family Medicine and Public Health Together: Co-location as a structural support to collaboration

Jessica Hopkins, MD, MHSc, CCFP, FRCPC, Hamilton, ON; Kelty Hillier, MSc, Hamilton, ON; Cathy Risdon, MD, DMan, CCFP, FCFP, Hamilton, ON; Jessica Hopkins, MD, MHSc, CCFP, FRCPC, Hamilton, ON

Description: Introduction: In May 2015, Hamilton Public Health Services and the Department of Family Medicine (DFM), McMaster University, including one of two sites of the McMaster Family Health Team (FHT) co-located in the same building. To our knowledge, this is the first organization-level co-location of a public health unit, DFM, and FHT. This poster will describe early observations on

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE collaboration. Method: A narrative description of the process and outcomes to date will be provided. This will include an inventory of current collaborations between Public Health (PH) and Primary Care-Family Medicine (PC-FM) and a description of the process to develop collaborative goals. A reflective discussion of known strengths and constraints of the organizations will occur. Results: The inventory of collaborations demonstrates that much baseline work between PH and PC-FM is occurring, but that it is generally not deliberate at an organization-level. Short-term collaborative goals included: 1) developing a committee to build knowledge of and relationships with the other organizations, 2) planning a shared continuing professional education agenda, and 3) planning to implement increased smoking cessation programming. Longer-term shared goals are under development and the results will be available in fall 2015. Lastly, known strengths and constraints of PH and PC-FM will be discussed. Early reflections show the strengths of PH to be population-based, strong background in health promotion, and mass media/public communications campaigns, but constrained by a formal organizational structure and high administrative processes burden. Comparatively, PC-FM has more distributed accountability for research and innovation, a strong background in secondary and tertiary prevention, strong individual-level relationships with patients, but is more limited than PH in reach (distinct patient population) and coordination of efforts at the organization-level (i.e., less clear priorities). Conclusion: PC-FM and PH collaborations support a larger continuum of care than either organization could individually. Much collaboration between PC-FM and PH exists in the normal course of work, but deliberate planning and resources can help to ensure these collaborations support organization-level goals and priorities.

Acknowledgement of the uniqueness of each group within the larger group can build on organizational assets and minimize silos.

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Not Every Low Back Pain is a Radiculopathy

Pankaj Bansal, MD, CCFP, Hamilton, ON; Laura Grennan, Hamilton, ON; E. Semenov, MD; Shanker Nesathurai, MD, MPH, FRCP(C), Hamilton, ON

Description: A 66-year-old man with a history of chronic low back pain and three previous spine surgical procedures presented with new onset, acute, excruciating low back pain with dysesthesias radiating to the left leg, left leg weakness, and difficulty walking. There were no red flag signs.

There was no focal weakness. The left ankle reflex was diminished. Sensation was decreased on the lateral foot, ankle, and lower leg. An acute left S1 radiculopathy was suspected. MRI did not reveal any changes from previous. Three weeks later, a diffuse vesicular rash appeared on his left leg. His examination remained unchanged with decreased sensation to S1-S3 dermatomes. He was diagnosed with acute herpes zoster complicated by lumbosacral postherpetic neuralgia (PHN). Over a period of 2.5 months, he was treated with oral acyclovir, tricyclic antidepressants (TCAs), oxycodone, gabapentin, physical therapy, and TENS (transcutaneous electrical nerve stimulation). His pain improved and he eventually returned to full function. Herpes zoster can manifest as low back pain and dysesthesias, despite initially suggesting a radiculitis. Reactivation commonly affects elderly and immunocompromised patients with an acute vesicular eruption distributed along adjacent dermatomes with severe pain and/or allodynia. [1] The most common neurologic complication is postherpetic neuralgia (abnormal sensations and severe, intractable pain or allodynia occurring one month after rash onset). [2] Early diagnosis and aggressive management of herpes zoster can alleviate symptoms and improve quality of life. All persons over 50 years of age and most persons under, should receive an oral antiviral within 72 hours of rash onset. [1,2] Adjunctive corticosteroids do not have any affect on quality of life or development of PHN. [3] The treatment of acute pain and PHN may include TCAs, gabapentin, carbamazepine, narcotics, topical anesthetics, transcutaneous electrical stimulation, acupuncture, regional sympathetic nerve blocks, intrathecal or epidural analgesia and lastly neurosurgical procedures.

[1,4-7] Prevention with vaccination is recommended.[8] 718

Designing Better CPD in Emergency Medicine for Rural Family Physicians Marianne Yeung, BSc, MD, CCFP(EM), FCFP, Ottawa, ON

Description: Context: Rural family physicians often work solo, and identify higher needs for continuing professional development (CPD) in emergency medicine (EM) than their urban counterparts. The Community Emergency Medicine Outreach program (CEMO) aims to address these needs, and has been offered on-site at 12 rural hospitals in Eastern Ontario since 2009. Topics in adult EM are chosen by and tailored to the needs of each hospital’s team of emergency health professionals, and discussed at half-day outreach sessions. Objective: To apply concepts learned during a Masters of Health Professions Education program to further develop the CEMO program. Intervention: The CEMO program director participated in the Masters program, supported by a CFPC Janus CPD Grant. New knowledge, skills and attitudes were applied to CEMO. Findings: Five important lessons learned, and their impacts on CEMO: Firstly, curriculum design is a dynamic and changing process; participants in CEMO now include many nurses, administrators, pharmacists, and junior learners as well as physicians. The content of each session is determined by each group to best serve their perceived and unperceived needs. Secondly, learning is most effective when it has high relevance to the local clinical context; CEMO’s teaching strategies include case-based learning, interactive discussion and simulation.

Fostering learning among interdisiciplinary team members will promote translation of new knowledge into EM practice. Thirdly, it is more effective to integrate new technologies into a curriculum than to treat these as separate stand-alone educational endeavours. CEMO sessions include new presentation software, screencasts, procedural videos, and online audience response systems as tools to engage participants.

Fourthly, participants may assess effectiveness of learning through reflection, multiple assessments over time, and multiple sources of assessment. CEMO encourages reflection during and after sessions, and considers participants’ views on their new skills, knowledge and behaviours and their coworkers’ reactions. Finally, program evaluation can take many forms, and begins with consideration of evaluation goals and questions. A program logic model has been developed for CEMO, and a combined process and outcome program evaluation is in progress. Conclusion: Applying important educational concepts can promote the design of effective emergency medicine CPD for rural family physicians.

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Documentation de la lisibilité des documents d’information remis aux patients - Saguenay Lac St-Jean Éva Marjorie Couture, MD, CCMF, Chicoutimi, QC; Maxime Dionne MD,Saguenay, QC; Dominic Cantin MD,Saguenay, QC; Benjamin Phaneuf MD, Alma, QC; Stéphanie Marceau MD,Saguenay, QC; Étienne Guillemette-Munger MD, Alma, QC; Catherine Potvin MD, MSc,Saguenay, QC; Mathieu Létourneau MD, Alma, QC; Marie-Ève Gaudreault-VIlleneuve MD, Alma, QC; Mylène Lévesque MSc,Saguenay, QC; Mélissa Lavoie, MSc,Saguenay, QC

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Description: Contexte: Au Canada, le niveau moyen de littératie en santé est faible. Au Saguenay–Lac-Saint-Jean, 76 % de la population a un niveau de littératie en santé insuffisant. La littératie englobe plusieurs concepts dont la capacité de lecture. Du point de vue des documents, la lisibilité sert, en partie, à évaluer le niveau de lecture nécessaire pour comprendre un document. Des données américaines suggèrent que les documents demandant de quatre à six ans de scolarité sont favorables à la compréhension par les patients. Objectif: Documenter le score de lisibilité des documents d’information remis aux patients fréquentant les CSSS et UMF de Lac-Saint-Jean-Est et ceux de Chicoutimi. Plan : Étude descriptive Population cible: Les documents à visée éducative remis aux patients se présentant aux CSSS et UMF de Lac-Saint-Jean-Est et ceux de Chicoutimi. La taille d’échantillon est de 71 documents.

Instruments : Les formules Simple Measure of Gobbledygook (SMOG) et Flesh-kincaid ont été utilisées pour calculer le score de lisibilité. La formule SMOG est la plus adaptée au domaine de la santé et le Flesh-Kincaid est la plus utilisée. La formule SOL a par la suite été utilisée pour convertir le score du SMOG pour la langue française. Mesure des résultats : 71 textes ont été choisis aléatoirement et ont été analysés afin d’évaluer le niveau de scolarité nécessaire pour comprendre chaque document analysé.

Un accord inter-juges (90%) a été réalisé au préalable. Résultats : Les textes analysés démontrent un score moyen de SOL de 8,7 (écart-type 1,4) et un score moyen de Flesch-Kincaid de 13,6 (écart-type 2,2) années de scolarité. 98,6 % des textes avaient un score SOL supérieur à quatre années de scolarité, comparativement à 100 % pour le Flesch-Kincaid. 97,2 % des textes avaient un score SOL supérieur à six années de scolarité, comparativement à 100 % pour le Flesch-Kincaid. Conclusion: Le niveau de lecture des textes analysés est supérieur au niveau de lisibilité recommandé pour la compréhension d’un document. Cela peut nuire à la compréhension des patients.

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Developing Quality Indicators for Collaborative Mental Health Care: A mixed-methods study

Abbas Ghavam-Rassoul, MD, MHSc, CCFP, FCFP, Toronto, ON; Nadiya Sunderji, MD, FRCPC, Toronto, ON; Gwen Jansz, MD, PhD, CCFP, FCFP, Toronto, ON; Anjana Aery, MPH, Toronto, ON; Allyson Ion, MSc, Toronto, ON; Amanda Abate, MD, Toronto, ON

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Description: Collaborative mental health care is widely implemented in primary care settings, but often is not informed by evidence-based practices. This poster presents findings from an effort to develop quality indicators for collaborative care. We are conducting a mixed methods study to develop quality indicators for collaborative mental health care in primary care. Through a scoping review of peer-reviewed and grey literature we are identifying quality indicators and classifying them using the Institute of Medicine and Donabedian frameworks. We are purposively sampling mental health and primary care providers, and consumers, to participate in qualitative interviews, and thematically analyzing interview transcripts to identify indicators. Based upon the literature and qualitative phase, we will conduct a modified Delphi expert consensus process regarding the relevance of the identified metrics. Using the CIHR’s Knowledge-to-Action framework, we are engaging an advisory group of primary care and mental health providers, people with lived experience of mental illness, and quality improvement experts to guide interpretation of the findings. Through a systematic search strategy we have identified 3762 literature sources to date, of which 202 met screening criteria. We have interviewed 13 healthcare providers. The work to date suggests that: a) co-location and adequate funding are integral to implementation, b) a tension exists between implementing evidence-based models versus adapting a model to the local context, c) team dynamics, relational skills, and physician buy-in may presage the functioning of a service, and d) high functioning teams may engage in multidirectional knowledge exchange, expanded scopes of practice and blurring of roles. Existing literature is heavily weighted toward evaluation of individual outcomes such as depression symptom severity, health status and level of function, whereas qualitative sources emphasized collaborative processes between clinicians, and facilitators and barriers to implementation. The research team and its advisory group have been able to incorporate overarching principles for collaborative care (e.g. equitability of access to care, meaningful choices available to consumers) and front-line perspectives on program operations (e.g. care management is available) The development of quality indicators will provide a consistent method by which to evaluate and improve the quality of collaborative mental health care in primary care.

721 Advocacy in Action: Implementation of a Family Medicine Advocacy Project in the University of Toronto Longitudinal Integrated Clerkship

Sharonie Valin, MD, CCFP, MHSc, Toronto, ON; Karen Weyman, MD, CCFP, Toronto, ON; Stacey Bernstein, MD, RCPSC, Toronto, ON; James Owen, MD, CCFP, Toronto, ON; Phiip Berger, MD, CFPC, Toronto, ON

Description: Context: Advocacy is a CanMEDs core competency and it is something that we role model as Family Physician teachers regularly.

However, it can be challenging to formally teach and evaluate. In 2014, the University of Toronto piloted a 51-week, longitudinal integrated clerkship (LInC) in an urban Academic Health Science Centre, with seven students. This provided an opportunity for innovation in advocacy teaching. Objective: To address this curricular competency, a formal advocacy project and evaluation tool was designed and implemented as part of the Family Medicine curriculum. Design: Students were instructed to identify a patient from their panel (a group of patients they follow longitudinally throughout the year), for whom social factors were significantly impacting their health and explore resources available to prepare an advocacy plan. Projects comprised of a presentation and abstract reflection were completed in five months, under the support of an identified faculty lead. The seven students were formally evaluated on a small group presentation and an abstract, which included a reflective component. A rubric was developed to evaluate: the advocacy issue, methodology, research and outcomes of their advocacy plan. This comprised 12% of their Family Medicine final evaluation.

Findings: The students explored interventions regarding: medication access, housing, smoking cessation, and food security. Feedback from students revealed that they found the project feasible and meaningful. Unexpectedly, the project reinforced the value of the

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE interprofessional team when advocating for a patient. A key finding post-project, was student self-report of continued application of advocacy skills in clinical care. Faculty found the project evaluation tool easy to use. Conclusions: The UofT LInC program successfully piloted a project that integrated advocacy training and evaluation of this core competency within the Family Medicine course. The project allowed students to explore ways of practicing and finding meaning in social responsibility. From an educator’s perspective, we developed a project and tool that allowed for formal evaluation of an otherwise difficult skill to assess. This project will continue as part of the LInC program for next year. U of T is looking at integrating advocacy into the Block Family Medicine clerkship rotation.

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Social Accountability Considerations for the Restructuring of a Family Medicine Residency Training Program Danielle O’Keefe, MD, CCFP, MSc, St. John’s, NL; Kristin Harris Walsh, PhD, St John’s, NL

Description: Context The Family Medicine residency training program at Memorial University in Newfoundland and Labrador trains residents for urban, rural and remote practice. With opportunities across Newfoundland and Labrador, New Brunswick and Nunavut, residents train in a variety of settings. Until recent years, residents completed short-term block training, resulting in little opportunity for integration into the clinic, hospital and community while requiring significant travel between training sites. In response to the CFPC Triple C curriculum changes as well as feedback from residents and preceptors, the residency training model was revised to reflect extended training opportunities in rural teaching sites across NL. Objectives • To learn how social accountability considerations led to a significant change in resident training opportunities in one Family Medicine program. • The early impact of residency training restructuring on the community. Design/Intervention In 2012, longitudinal integrated training opportunities were discussed at site visits and preceptors were asked to consider additional training options at their site. Based on this feedback, during the 2013-15 academic years a number of rural sites offered longitudinal integrated training to second year residents. The training increased from four months to six, eight, ten or thirteen training blocks depending on the site. As of 2014-2015, 49% of second year residents had the opportunity to complete longitudinal integrated training. Population Family Medicine residents and preceptors. Results Residents have stated a desire to “live in one place” and to “not move around” so often. Satisfaction with the rural Family Medicine rotation has increased over the past three years from 75% in 2011-2012 to 92% in 2013-2104. Preceptors reported satisfaction with the new training model. There has been recruitment success with this new model of training. Conclusion The longitudinal integrated training program has decreased resident travel and increased satisfaction of both residents and preceptors. We have begun to see improved recruitment to many of our rural sites and are thereby helping fulfill Memorial’s social accountability.

723 Defining Priorities for the Assessment of Competence in Care of the Elderly by Family Physicians: The priority topics

Lesley Charles, BSc, MBChB, Edmonton, AB; Chris Frank, MD, FCFP, Kingston, ON; Marcel Arcand, MSc, MD, FCMF, Sherbrooke, QC; Sidney Feldman, MD, CCFP, Toronto, ON; Robert Lam, MSc, MD, CCFP, Toronto, ON; Prabin Mehta, MBChB, CCFP, Winnipeg, MB; Tim Allen, MD, CCFP(EM), FRCPC, Toronto, ON; Nadia Mangal, Toronto, ON; Tatiana Lozanovska, Toronto, ON

Description: Context With Canada’s senior population increasing, there is a greater demand for family physicians with enhanced skills and added competency in care of the elderly (COE). The College of Family Physicians Canada has introduced Certificates of Added Competence (CACs) in five domains, one being COE. CAC awards will be based on the demonstration of specific competencies. The first steps of defining these competencies are a determination of the priority topics. Objective To determine priority topics for the assessment of competence in COE. Design A modified Delphi technique was used with on-line surveys and face-to-face meetings. The Working Group (WG) of six physicians, with enhanced skills in COE, acted as the nominal group, and a larger group of randomly selected practitioners from across Canada acted as the Validation Group (VG) Intervention The WG, and then the VG, completed electronic write-in surveys that asked them to identify the priority topics. Responses were compiled, coded and tabulated to calculate the frequencies of selection of topics. The WG used face-toface meetings and iterative discussion to decide on the final topics. Outcome A list of priority topics for the assessment of competence in COE, validated by correlating the input from the WG and the VG. Results There was as 19% response rate (41 of 212) from the VG. Most respondents from the VG are involved in teaching, and about one quarter are Program Directors. Half of them have more than 10 years of experience, and 45% have a focused practice. The correlation between the specific priority topic list identified by the VG and that identified by the WG is 0.68. The final list has 18 priority topics. There is an even higher correlation (0.89) for the generic skills of competence that were independently identified by the VG and the WG. Conclusion Defining the required competencies is a first step to establishing national standards in COE and these standards can be the basis for awarding CACs. The methodology used and the high correlation between the lists generated by the WG and the VG suggest that this priority topic list is valid for COE. 733

Potentially Avoidable Emergency Department Visits for Family Practice Sensitive Conditions Geoff Paltser, PhD, Toronto, ON; Josh Fagbemi; Cheryl Gula

Description: Context Canadians visit the emergency department (ED) frequently, at times for minor medical problems that might be more appropriately treated elsewhere. Many jurisdictions are evaluating strategies to reduce avoidable ED visits, and identifying and quantifying these visits can help efforts to improve appropriateness of care. Objective This study from the Canadian Institute for Health Information (CIHI) examines ED utilization to identify visits that may be more appropriately managed at a family physician’s office or clinic, known as family practice sensitive conditions (FPSCs). Design ED visits for primarily low acuity reasons where patients were not admitted to inpatient beds were calculated and compared to rates of visits for other reasons. Possible explanatory factors including diagnosis and acuity, time of visit, length of stay, and patient age, SES, and rurality were examined. Target Population Included in the analysis are all unscheduled visits to EDs (excluding urgent care centres) in 2013–2014 where patients were discharged home. Instrument This study uses data from CIHI’s National Ambulatory Care Reporting System (NACRS). The following jurisdictions submitted ED data with complete ICD-10-CA diagnoses in 2013-2014 and are included in the results: Ontario (all facilities); Alberta (all facilities); Nova Scotia (5 facilities); Saskatchewan (4 facilities); P.E.I. (1 facility); and Yukon (1 facility). Results Overall, 1 in 5 non-admitted ED visits were for FPSCs, totaling more than 1.4 million visits in 2013-2014. The most common reasons for these visits included upper respiratory infections (13%), antibiotic therapies (13%), sore throats (8%), ear infections (7%) and care following surgery such as dressing changes and removal of stitches (5%). More than one-third (35%) of non-admitted visits

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for children younger than age 5 were for FPSCs, compared with only 12% for patients age 85 and older. Additionally, 32% of nonadmitted ED visits among rural-dwelling patients were for FPSCs versus 17% among urban-dwelling patients. Conclusions Providing care for patients presenting with FPSCs in settings such as doctors’ offices and clinics may improve continuity of care and the patient experience, and allow ED resources to be focused on those who more appropriately require them.

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Measuring the Patient Experience in Primary Care: Comparing email and waiting room survey delivery Morgan Slater, PhD, Toronto, ON; Tara Kiran, MD, CCFP, MSc, Toronto, ON

Description: Context: Measuring the patient experience is an integral step towards understanding and improving the quality of primary care.

Finding the capacity to regularly survey patients can be challenging in a busy family practice and traditional methods can be costly and burdensome. Electronic surveys sent via email offer a low-cost alternative, however the method of data collection can influence survey responses. There is little literature to guide family practices on how patient characteristics and responses might differ when conducting patient experience surveys using different delivery methods. Objective: To compare the characteristics and responses of patients completing a patient experience survey accessed online after email notification or delivered in the waiting room via tablet computers. Design: Cross-sectional comparison of two methods of survey delivery Participants: Family health team patients aged 18+ who completed an email survey between January and June 2014 (n=587) or in the waiting room in July and August 2014 (n=592).

Intervention: None. Outcome Measures: Comparison of respondent demographics and responses to questions related to access and patient-centredness. Results: Patients responding to the email survey were more likely to live in higher income neighbourhoods (p=0.0002) and had a different age (p=0.0147) and gender (p=0.0434) distribution than those responding to the waiting room survey; there were no significant differences in self-rated health. Patients responding by email were less likely to report being able to see a provider the same or next day when they were sick and needed care (53.3% email versus 60.2% waiting room, p=0.0265) but more likely to report their provider always or often spent enough time with them (89.2% versus 85.1%, p=0.0457); there were no differences in responses to other questions. Noted differences in responses disappeared after adjustment for patient demographics.

Conclusions: Our findings suggest that responses may differ depending on the method of survey delivery but these differences can be explained by differences in the characteristics of the respondents. New methods of delivery that require electronic literacy may under-represent patients from low-income neighbourhoods.

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Reach and Uptake of the Canadian Task Force on Preventive Health Care’s Clinical Practice Guidelines Nadia Bashir, PhD, Toronto, ON; Julia E. Moore, PhD, Toronto, ON; Charmalee Harris, BSc, Toronto, ON; Marcello Tonelli, MD, Calgary, AB; Sharon E. Straus, MD, Toronto, ON

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Description: Despite the large volume of published preventive health care research, many primary care practitioners (PCPs) routinely engage in practices that are not based on evidence. The Canadian Task Force on Preventive Health Care (CTFPHC) aims to minimize this knowledge-to-action gap by developing and disseminating evidence-based clinical practice guidelines for preventive care. Focusing on activities in 2014, we assessed the CTFPHC’s success in accomplishing this goal by examining whether CTFPHC guidelines that recommend substantial changes in practice (i.e., breast [2011], cervical [2013], and prostate [2014] cancer screening) are reaching stakeholders and promoting practice changes. We measured reach by analyzing data on the CTFPHC’s key dissemination activities (e.g., guideline and knowledge translation [KT] tool distribution). We also administered a survey to PCPs (N = 96) and conducted semi-structured interviews with them (N = 26) to assess self-reported current practices, awareness of CTFPHC guidelines and KT tools, and practice changes. Results revealed that the CTFPHC guidelines and KT tools have been viewed over 170,000 times and downloaded over 21,615 times. In addition, many survey and interview participants were aware of the guidelines and found them to be useful. Of these participants, 30-50% were aware of the KT tools and a similar proportion reported making practice changes based on the guidelines. When describing their current practices at the beginning of the survey or interview, however, most participants self-reported engaging in practices that were consistent with many of the CTFPHC’s breast, cervical, and prostate cancer screening recommendations. Participants also provided several suggestions for increasing reach and uptake of the guidelines: (a) clarify differences between CTFPHC guidelines and other guidelines, (b) provide resources to support implementation, (c) disseminate guidelines and KT tools broadly, and (d) develop patient-focused resources. In sum, many Canadian PCPs are aware of the CTFPHC’s breast, cervical, and prostate cancer screening guidelines and seem to be engaging in practices that are consistent with the guidelines. The results of this evaluation and the suggestions provided by participants identify ways in which the CTFPHC can improve its resources and activities aimed at supporting PCPs in delivering preventive care.

Women’s Experiences of Contemporary Home Birth in Newfoundland and Labrador: A qualitative study Kelly Monaghan, MD, PhD, St John’s, NL; Patrick Fleming, MD, MSc, Toronto, ON

Description: Background: Home birth is becoming increasingly common across Canada. In Newfoundland and Labrador (NL), approximately 12-15 women make this choice every year. Very little is known about the experiences of these women or home birth outcomes since they largely take place outside of the formal maternity care system. Methods: Using semi-structured individual interviews, this qualitative research project explores the experiences women who chose to home births in St John’s, NL between 2011-2014.

Participants were recruited through the province’s sole practicing homebirth midwife. Interviews were transcribed and manually coded. We used thematic analysis to examine our data. Ethics approval was received from the local ethics board. Results: We included 11 women between the ages of 27-41 years who experienced 17 home births during the reference period. Participants

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE tended to have higher levels of education and income than the general population with 81% having a university education and 64% exceeding the province’s median household income. In our interviews, women discussed the reasons for their choice, outcomes of the experiences, some of the challenges they faced in arranging homebirth, and changes they would like to see to the formal maternity care system. Conclusions: Common reasons for choosing homebirth included the influence of peers, positive media representations, and prior unfavourable hospital experiences. Women reported satisfaction with the perceived comprehensiveness and family-centered nature of homebirth care. All participants expressed a desire for more choice in maternity care providers and seamless integration of legislated and publically funded midwifery services. This study addresses a significant knowledge gap on homebirths in Newfoundland and Labrador.

737

Development of Medical Imaging Pathways for Primary Care by Primary Care

Lilly Whitham, MSc, PMP, Toronto, ON; Jeff A. Bloom, MD, CCFP, FCFP, Toronto, ON; Karen Weiser, MBA, Toronto, ON; Ravi Menezes, PhD, Toronto, ON; Jisla Mathews, MBBS, MBA, Toronto, ON; Catherine Wang, Toronto, ON

Description: Purpose: Medical imaging is a complex field, with rapidly advancing technology and variability in referral patterns. The provincial Diagnostic Imaging Appropriateness (DI-APP) Project was launched in 2014 by the Joint Department of Medical Imaging at the University Health Network to partner with primary care providers and build tools to assist with imaging referral decisions. The project aimed to develop robust, Ontario-specific, evidence-based pathways, framed in the primary care lens for common clinical scenarios, like headache and low back pain. Participants: The imaging pathways were developed collaboratively by multidisciplinary panels of over 50 members that included primary care providers, radiologists and relevant specialists from urban, suburban and rural practice settings. Primary care providers were placed in leadership positions to ensure applicability of the format and content to their practice. Methods: The pathway development methodology was informed by elements of the CAN-IMPLEMENT framework for guideline adaptation. Key steps involved guideline screening and summarization, assessment of recommendations via online surveys by clinician panels, meetings to resolve discordances and consensus building of the final pathway via modified Delphi technique. To develop an implementation strategy, a focus group was conducted to identify barriers and opportunities to pathway acceptance and adherence. Results: Using the consensus-based methodology, panel members successfully developed pathways for low back pain and headache and will continue with TIA/stroke and knee pain. The starting point of each pathway involves subcategories that combine specific symptoms and patient histories that should allow physicians to easily determine which management route to take. These subcategories are designed to reflect the initial assessment by primary care providers and align with current guidelines. Strong clinician engagement has been a key success factor and has been sustained over many months, ranging from 80-90% meeting attendance. Survey response rates have been consistently high as well, ranging from 70-80%. Conclusions: The imaging pathways are expected to be applicable to the local practice setting and accurately reflect patient presentation in primary care. Key to achieving widespread adoption will be integrating pathways into primary care providers’ workflow and an implementation strategy that includes training and educational tools.

738

Innovative Practices in Primary Health Care for Alzheimer’s Disease and Related Disorders

Isabelle Vedel, MD-MPH, PhD, Montreal, QC; Claire Godard-Sebillotte, MD, PhD (Cand); Geva Maimon, PhD; Geneviève Arsenault-Lapierre, PhD; Mélanie Le Berre, MSc; Isabelle Vedel, MD-MPH, PhD; Liette Lapointe, PhD;

Introduction: According to the World Health Organization, Alzheimer’s disease and related disorders (ADR) are “perhaps the 21st century’s most serious health challenge” (WHO, 2012). Most primary healthcare (PHC) professionals are not prepared to deal with ADR patients, resulting in delayed diagnosis and late intervention. To increase PHC’s capacity to cope with this population, new clinical and organizational practices must be implemented. This study investigates the impact of a report on ADR recently disseminated in Quebec. It aims to quantify quality of care, and identify organizational factors explaining performance. Methods: A convergent design, mixed methods study was conducted. Eight Family Medicine Groups (FMG) were studied. Retrospective chart reviews collected data on diagnosis and follow up procedures, before and after the report. A ranking scheme was developed to quantify the performance of the FMG based on these data. Semistructured interviews with key actors made up the descriptive qualitative study, which sought to determine the factors that can explain the performance rankings. Results: High performing clinics had the following characteristics: 1)Highly motivated family physicians (FP) with the confidence and tools to make diagnoses and initiate treatment. 2)Nurses who collaborated with FP, and whose extended roles included both the initial assessment of patients and their follow-up. 3)There was one physician who took on the role of leader and championed the cause for change. 4)There was an ongoing communication between the FMG and specialists, who not only provided expert advice and training to the FP and nurses, but also worked with the champion to develop clinical tools. Varying degrees of these characteristics were observed for the lower ranking FMG. Conclusion: This paper suggests that, under specific circumstances, innovative interventions in PHC are indeed feasible, even in the case of passive diffusion of a report. Given that the implementation and diffusion of innovative interventions is challenging, it is essential to identify the key factors linked with better quality of care in order to customize the interventions and achieve promising results.

Based on the results from this study, the Quebec Ministry of Health has further developed the Alzheimer plan.

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Impact of Antidepressants on Blood Sugar Among Canadian Primary Care Patients With Type 2 Diabetes Justin Gagnon, MA, Montreal, QC; Marine Hardouin, Marie-Thérèse Lussier, MD, BSc, MSc, FCMFC; Gillian Bartlett-Esquilant, PhD, MSc

Description: Context: Depression is a common comorbidity in people with diabetes and is associated with increased risk of poor glycemic control compared with those without depression. While treatment of depression is expected to improve glycemic control, evidence suggests that certain antidepressants exacerbate glucose metabolism, further increasing the risk of poor control. Evidence on the effects of the majority of antidepressants on blood sugar among people with diabetes and depression, however, remains inconclusive. Objectives: The objectives of this study were to describe the antidepressant prescription practices among primary healthcare providers for patients with type 2 diabetes and depression, and to measure the impact of the top prescribed antidepressants on their blood sugar. Design: A population-based cohort study was undertaken. Participants: The study sample comprises diabetic patients seen in Canadian primary care practices between 2008 and 2014 and having been prescribed an antidepressant as treatment for depression. Instrument: Patient health data was obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The CPCSSN chronic disease database contains anomymized health information obtained from electronic medical records across Canada. Outcome measures: The principle outcome is the change in glycosylated hemoglobin (HbA1c) measured prior to and following an antidepressant prescription. A multi-linear regression model was computed to fmf.cfpc.ca

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measure the extent to which HbA1c varies following exposure to one of the top prescribed antidepressants. Results: Tricyclic and tetracyclic antidepressants and monoamine oxidase inhibitors (which studies suggest cause weight gain and hinder glycemic control) are seldom prescribed by Canadian healthcare providers for people suffering from type 2 diabetes. Results on the impact of antidepressants on blood sugar will be presented at the conference.

740

Emailing Discharge Instructions: Does it click with patients?

Michael Heiber, MD, CCFP (EM), Scarborough, ON; Christine D. Connelly, PhD, Toronto, ON

Description: Context: Patient education can influence disease management in certain medical conditions treated in the emergency department (ED) and in family practice. Traditionally, patient education has involved sending patients home with paper handouts or a web address jotted down on a sheet of paper. However new technology can more reliably connect patients with resources. Objective: The purpose of this study is to evaluate the utility of a computer program which send emails to patients with links to relevant patient education resources. Design: The study involves database and survey analysis. Particpants: Participants include a convenience sample of 200 ED patients, including adults and children with a diagnosis corresponding to one of five specific topics (head injury/ concussion, asthma/COPD/bronchitis requiring an inhaler prescription, fractures, stitches and fever in children). Intervention: We selected five health topics commonly seen in the ED and created webpages for each one with relevant information culled from the Internet, which we reviewed. On discharge, patients were directed to a desktop computer in the ED running a software program we created. This program was accessible to emergency doctors, nurses, cast technicians and respiratory therapists. Consenting patients would type in their email address and answer three survey questions. The program would send each patient a personalized email with a link to a webpage pertaining to his/her health problem. Using click-tracking software, we collected data on whether patients opened this email message and accessed links on the provided webpage. Findings: In the first month of the study, preliminary findings showed that 11 out of 20 patients logged onto the website after discharge from the ED. Conclusions: Patient engagement with discharge instructions remains a challenge for clinicians. However, using a computer program to email patients tailored information is a promising approach to improving disease management which could be even more feasible in family practice than in the ED. 741

Exploring the Barriers to Depressed Family Medicine Residents Accessing Mental Health Services

Todd Hill, PhD, Calgary, AB; Kelsey MacLeod, MD, Calgary, AB; Todd Hill, PhD, Calgary, AB; Alex Kirvan, MD, Calgary, AB; Kim Taylor, MD, Calgary, AB

750

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Description: Medical learning environments are stressful. Prolonged exposure to stress can negatively impact residents’ performance academically as well as their physical and psychological well being, making them vulnerable to depression. Given that medical trainees are at an elevated risk of depression, access to mental health resources is important. Givens and Tjia (2002) looked at depressed medical students and found that only 22% of them were utilizing mental health counseling services. The most common perceived barriers were lack of time, lack of confidentiality, stigma, cost, fear of documentation on academic record, and fear of unwanted intervention.

In the present study, the survey used by Givens & Tjia (2002)was given to 127 Family Medicine residents at the University of Calgary.

Results indicate that 69.7% residents had below threshold symptoms of depression, 15.6% residents’ scores were suggestive of mild depression, and 14.7% residents scores were suggestive of moderate to severe depression. When we looked at the residents who met criteria for moderate / severe depression (BDI - SF = 8 or higher), only 5 of the 16 residents (31.3%) reported seeing a counselor, and of those, only 1 was seeing a counselor provided by the university. The remaining 4 residents with moderate / severe depression reported receiving services outside of the institution. Similar to Givens & Tjia’s results, the most common barrier identified to accessing mental health services was the lack of time to use services. The second most frequently identified barrier was fear of lack of confidentiality, followed by: fear of negative impact on career, fear of unwanted intervention, stigma, hard to find accesses / services, concern that no one will understand problems, cost, and fear of documentation on school record. The present results add to the work presented by Givens & Tjia indicating that time is a huge perceived barrier to accessing mental health services. Cohen and Patten (2005) found that time pressure was the leading factor in residency-related stress. These findings would suggest that time pressure is both a perceived cause of mental health problems and a barrier to accessing mental health services.

Health Care Provider Perceptions of the Identification of Adults With Suspected Mild Intellectual Disability Meg Gemmill, MD, CCFP, Kingston, ON; Mary Martin, MSc; Nicole Bobbette, MSc; Elizabeth Grier, MD, CCFP; Ian Casson, MD, MSc, FCFP

Description: Context: Adults living with intellectual and developmental disabilities (IDD) often experience complex physical and mental health issues, highlighting the importance of ongoing follow-up and management by family physicians and supportive allied health services. For adults with a previously undiagnosed IDD, a psychological assessment is recommended by the Canadian Consensus Guidelines for the Primary Care of Adults with Developmental Disabilities to confirm the diagnosis of IDD and prompt funding for community services. However, this is not easily adhered to, as the high cost is not subsidized by many health or social service systems. The purpose of this study is to explore the perceptions of family physicians (FP) and allied health providers (AHP) towards the need and potential use of an affordable, in-office IDD identification tool. Objectives: 1) exploring physician and allied health provider experiences with IDD diagnosis and assessment processes, 2) determining adherence to Canadian Consensus Guidelines, 3) determining perceived need and attitudes towards the use and usefulness of an identification tool designed for use in primary

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SCIENTIFIC PROGRAM | FRIDAY 13 VENDREDI | PROGRAMME SCIENTIFIQUE or allied healthcare settings. Design: To address objectives, we are carrying out a multi-method study. Here we present results of an online questionnaire that combines measures of agreement and free-text responses. Quantitative data will be analyzed using descriptive statistics and free-text responses through thematic analysis by two independent researchers using NVivo(10). Participants: Questionnaire will be distributed among currently practicing FP and AHP with past or present clients having diagnosed or undiagnosed IDD, working in Family Health Teams in south-eastern Ontario, Canada. Results: Data collection and analysis ongoing. We anticipate highly variable experience with identification processes and low adherence to Canadian Consensus Guidelines. Conclusions: Adults with undiagnosed IDD are a vulnerable population in need of enhanced primary care and allied healthcare support. This questionnaire will inform the development of an interview script with key stakeholders in community organizations to gain an organizational perspective of the issue. Study results will support the future development of an in-office IDD identification tool.

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Perceived Competence in Performing Procedures Among Urban and Rural Family Medicine Graduates Sharifi Nader, MD, CCFP, Surrey, BC; Maureen Sharko, MD, CCFP (EM), Kelowna, BC

Description: Context: Training family physicians to perform common outpatient procedures can increase job satisfaction, improve patient satisfaction, boost practice income and reduce health care costs. However, Residency programs in Family Medicine often do an inconsistent job providing adequate training in the Core Procedure Skills defined by the College of Family Physicians of Canada in 2005. Objective: The primary objective of this study was to perform a gap analysis to elucidate graduating Residents’ perceived comfort performing the 65 core procedures and their intention to perform these in their future clinical practice. Design: survey research Participants: Surveys were circulated to residents at two different Family Practice training sites of the University of British Columbia– one urban and one rural site. Inclusion criteria were PGY-2 Family Practice residents graduating in June 2014 and those completing their training within 3 months of this cohort. Outcome measures: Perceived comfort performing procedures and intention to practice as measured by a 5-point modified Likert scale developed for this study. Results were analyzed for variance between the urban and rural training sites. Results: Surveys were collected from 9 urban respondents (10 circulated; 90% response rate) and 8 rural respondents (13 circulated; 62% response rate). Significant differences were observed between the 2 UBC training sites in the areas of Emergency, OBGYN and Musculoskeletal procedures with rural graduates having greater perceived comfort and competency in the aforementioned. Individual comments from respondents were also highlighted to support the quantitative analysis. Conclusions: In this study we review current procedural skills curriculum at two UBC Family Practice Residency programs, report survey results from our gap analysis, and make suggestions for enhancing training in core procedures based on professional practice gaps and best practices in medical education.

janus cpd Posters / Affiches janus dpc NOVEMBER 13 NOVEMBRE – FOYER MTCC 752

Masters in Education: Studying to Become a Better Teacher

755

Designing Better CPD in Emergency Medicine for Rural Family Physicians

Ann S. O. Lee, CCFP, Edmonton, AB

Marianne Yeung, CCFP(EM), FCFP, Ottawa, ON

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S114835 A Binge-Eating Disorder, Obesity, and Primary Care: An intersection to improve patient care 06:45–07:45 Richard Ward, MD, CCFP, FCFP, Canmore, AB; Barry Simon, MD, CCFP, FRCPC, Toronto, ON; Paul L. Beck, BSc(Hons), MD, PhD, Calgary, AB 801AB MTCC Learning Objectives: 1. identify clinical situations where screening for binge-eating disorder would be appropriate 2. diagnose binge-eating disorder 3. describe evidence-based management options for binge-eating disorder Description: This session is meant to be an informal and interactive program that will raise awareness of binge eating-disorder in primary care. The format will be more conversational and casual between the two presenters, with an attempt to engage the audience in a dialogue.

Participants may claim an additional Mainpro-M1 credit for attending this session

S99587 Chronic Pain CPFM Networking Breakfast 07:00–08:00 Ruth Dubin, MD, CCFP, FCFP, Kingston, ON; Lydia Hatcher, MD, CCFP, FCFP, Ancaster, ON; Roman Jovey, MD, Mississauga, ON; Bruce Hollett, MD, CCFP, Conception Bay South, NL; Mark Ware, MD, Montreal, QC; Lori Montgomery, MD, CCFP, Calgary, AB; Greg Chernish, MD, Winnipeg, MB; Joel Bordman, MD, Toronto, ON 707 MTCC Learning Objectives: 1. connect with Canadian family physicians and residents who are interested in chronic pain 2. identify chronic pain issues relevant to colleagues across Canada 3. relate activities of the chronic pain CPFM committee in 2015 Description: This networking breakfast for anyone interested in chronic pain will bring together the chronic pain community of practice in family medicine. The breakfast will provide networking opportunities for Canadian family physicians and learners. Members of the CPFM committee can update attendees on the activities of the committee and hope to hear from attendees about the issues that are of relevance to our members from across Canada. Sharing information on practical skills, educational initiatives, and regional barriers or successes in pain management will be our goal.

S102350 Substance Use and Pregnancy Networking Breakfast 07:00–08:00 Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Alice Ordean, MD, CCFP, FCFP, Toronto, ON; Suzanne Turner, MD, CCFP, Toronto, ON; Maya Nader, MD, CCFP, Toronto, ON; Mel Kahan, MD, CCFP, FCFP, Toronto, ON; Pat Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON 713A MTCC Learning Objectives: 1. identify current issues in substance use in pregnancy for family physicians 2. share successes and challenges of caring for women with problematic substance use in pregnancy 3. network with colleagues who share similar interests

Nader Sharifi, BSc, MD, CCFP, ABAM, CCHP, Surrey, BC; Fiona Kouyoumdjian, MD, CCFP, PhD, Hamilton, ON; Lori Kiefer, Medical Consultant, Ontario Provincial Corrections 715B MTCC Learning Objectives:

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S102783 Prison Health Breakfast Networking Session: What you need to know to become a prison physician 07:00–08:00 Josiane Cyr, MD, CCFP, Montreal, QC; Margaret (Peg) Robertson, MD, CCFP, Kingston, ON;

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE 1. network with others who are interested in prison health 2. increase understanding of the steps involved in becoming a prison physician Description: During this informal breakfast networking session, prison physicians will share their personal narratives, in response to the following questions: What led me to become a prison physician? What steps did I take in order to become competent? How do I stay competent? How do I maintain my emotional resilience? Attendees of this networking session will be invited to share their own interest in and experiences of prison health, and to ask questions.

S102867 Developmental Disabilities Community of Practice Networking Breakfast: 07:00–08:00 Genetic assessment in the workup of intellectual disability and autism spectrum disorders

Elizabeth Grier, MD, CCFP, Kingston, ON 717A MTCC

Learning Objectives: 1. discuss new genetic testing techniques and their efficacy 2. describe the role of the family physician in assessment

S103724 07:00–08:00

Cancer Care Networking Breakfast 715A MTCC

Description: Do you have a special connection to the care of cancer patients? You are invited to join the new Cancer Care CPFM group at our networking breakfast! We'll meet each other, discuss ways that our new group can strengthen the work of FPs with a special commitment to cancer care, and be a better resource to our FP colleagues and to family medicine training programs. See you there!

S103752 07:00–08:00

Dermatology Networking Breakfast 717B MTCC

Description: The Dermatology Networking Breakfast will offer a short didactic session: "The Top 10 Mistakes We Make When Treating Our Dermatology Patients", followed by a group discussion around future initiatives in dermatology primary care.

S103760 07:00–08:00

Emergency Medicine Networking Breakfast 705 MTCC

Description: FMF Delegates are invited to share their knowledge and expertise in this specific area of interest at the Emergency medicine networking breakfast

S94708 08:30–09:30

Teaching Procedural Skills in Your Office Based on the Triple C Curriculum Juan Garcia-Rodriguez, MD, CCFP, MSc (Med Edu), Dip Sports Med, Calgary, AB 707 MTCC

Learning Objectives: 1. recognize the importance of procedural teaching as a part of the Triple C curriculum 2. identify family medicine CanMed roles in procedural teaching 3. list the steps for teaching procedures Description: This is an interactive session to review the steps required for successfully imparting procedural skills instruction and to review a model to understand skill acquisition. Emphasis will be put on recognizing this teaching activity as a crucial part of the Triple C curriculum. At the end of the activity participants will practise skills reviewed during the session and will receive feedback on the simulated teaching.

S95094 08:30–09:30

Approach to the Acutely Agitated Patient in the ED Vu Kiet Tran, MD, MHSc, MBA, CEUS, Richmond Hill, ON 714AB MTCC

Learning Objectives: 1. enumerate steps taken to de-escalate the agitation 2. enumerate precautions taken to prevent injury while performing physical restraints 3. enumerate most commonly used chemical restraints Description: In a busy emergency department where numerous things can happen at the same time and all of a sudden, knowing what to do is important.

This is especially true when it comes to dealing with the irritated patient who has waited for a long time or with the psychiatric patient who has suddenly decompensated. What is an appropriate approach? How to do it safely (for all parties involved)? When are physical or chemical restraints appropriate or inappropriate? Learn which medication is effective and safe. Become more comfortable in dealing with the acute agitated patient in a chaotic environment like the emergency department. fmf.cfpc.ca

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S96388 08:30–09:30

PMS: Pretty miserable syndrome Christiane Kuntz, MD, CCFP, FCFP, NCMP, Ottawa, ON 701A MTCC

Learning Objectives: 1. define “premenstrual syndrome” and examine the etiology/pathophysiology 2. describe the natural history across the life cycle and recognize the impact of PMS on health, wellness, and society 3. review clinical assessment tools for PMS, explore treatment options, and apply learning “pearls” through the review of cases Description: The session will begin with a definition of “premenstrual syndrome” and will continue with a description of the natural history of this disorder across the life cycle. The etiology and pathophysiology of PMS will be examined, recognizing the impact of PMS on health, wellness, and society. Clinical assessment tools for PMS will be discussed. This will be followed by an exploration of the hormonal, psychotropic, and alternative treatment options for PMS. Learning “pearls” will be applied through a review of real-life cases.

S99034 08:30–09:30

Identifying and Managing the ”Can‘t Miss” Headaches Dépister et prendre en charge les céphalées à ne pas omettre

Carolyn Rosenczweig, MD, CCFP, Surrey, BC HALL F MTCC

Learning Objectives: 1. use efficient tips and tricks to quickly and accurately identify a ”can‘t miss” headache 2. confidently manage the ”can‘t miss” headaches including identifying which patients need to be referred onwards for further tests and specialist care 3. learn which medications are potentially dangerous when dealing with patients suffering from headache—both acute and chronic Description: Headache is one of the most common presentations to a family practitioner‘s office or emergency department. Sometimes these headaches are due to potentially dangerous conditions, which, if missed, can leave a patient permanently disabled (eg, blindness due to a missed temporal arteritis) or dead (eg, missing the sentinel bleed in an evolving subarachnoid hemorrhage). In this session, attendees will learn efficient tips and tricks in conducting a focused history and physical exam that ensures ”can‘t miss” headaches are caught. The ”can‘t miss” headaches will be reviewed individually using a case-based format. The management of these headaches will be reviewed using methods from the most up-to-date research. By the end of this session, attendees will feel confident in being able to efficiently identify and manage both benign (eg, migraine) and ”can‘t miss” (eg, subarachnoid hemorrhage) high-risk headaches. In addition, attendees will know which pitfalls to avoid when dealing with patients suffering from chronic recurring headaches (eg, avoiding oral contraceptives and triptans in patients with classic migraines due to their increased risk of stroke).

Objectifs d‘apprentissage : 1. apprendre des trucs et conseils utiles pour dépister rapidement et avec précision une céphalée à ne pas omettre 2. prendre en charge les céphalées à ne pas omettre en toute confiance – y compris identifier les patients qui doivent être aiguillés pour recevoir plus de tests et des soins spécialisés 3. savoir quels médicaments sont potentiellement dangereux lors de la prise en charge d‘un patient souffrant de céphalées, aiguës et chroniques

saturday • samedi

Description : La céphalée est l‘une des raisons les plus courantes pour lesquelles un patient consulte un médecin de famille ou se présente à l‘urgence. Parfois, ces céphalées sont causées par une affection potentiellement dangereuse et, si elle nous échappe, peuvent handicaper un patient de manière permanente (p. ex., cécité causée par une artérite temporale non dépistée) ou causer son décès (p. ex., omettre le saignement sentinelle d‘une hémorragie sous-arachnoïdienne évolutive). Durant cette séance, les délégués apprennent des trucs et conseils pratiques pour effectuer une anamnèse et un examen physique ciblés assurant le dépistage des céphalées à ne pas omettre. Les céphalées à ne pas omettre sont étudiées individuellement dans une formule basée sur des études de cas. La prise en charge de ces céphalées est examinée à l‘aide de méthodes découlant de la recherche la plus récente. À la fin de la séance, les délégués pourront avoir confiance de pouvoir dépister efficacement et prendre en charge les céphalées bénignes (p. ex., migraine) et celles à risque élevé que l‘on ne peut omettre (p. ex., hémorragie sous-arachnoïdienne). En outre, les délégués savent quels pièges éviter lorsqu‘ils soignent des patients qui souffrent de céphalées chroniques récidivantes (p. ex., éviter les contraceptifs oraux et les triptans chez les patients souffrant de migraines classiques en raison du risque accru d‘AVC).

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S100369 08:30–09:30

From Notes to Reality: A songwriting workshop for (musical) medical professionals Ted Jablonski, MD, CCFP, FCFP, Calgary, AB 711 MTCC

Learning Objectives: 1. understand the elements of a song and basic song structure 2. mine creativity, convert daily writing into lyrics, and find rhythms and melodies 3. complete a simple song by the end of the session Description: If you are a musician and always wanted to write a song, this will be the best workshop you ever attend. If you have written songs and want to take your craft to the next level, consider this a “master class.” An unusually high percentage of medical professionals have extensive musical backgrounds and a genuine passion for the arts. But how many can say they have ever written a song? For most, even with formal music backgrounds, this may seem like a daunting goal as the process seems difficult, poorly defined, and shrouded in mystery. We are a very focused hard-working group of over-achievers but sometimes our creativity has been beaten down by the challenges of our career, family responsibilities, and lack of time. Throughout our careers we can struggle with finding balance in our lives and we can lose our sense of fun and creativity. Our love of music becomes a “luxury” that we cannot afford due to all our other pressing commitments. We document information each and every day as a technical part of our jobs. Can this skill be translated into creative writing and a song? This practical, hands-on, interactive workshop is designed to help musical physicians write a complete song, even if they have never tried in the past. Ted “dr j” Jablonski is an award-winning multi-instrumentalist singer-songwriter and family practitioner in Calgary. He has written and published over a hundred songs, has released seven independent CDs in blues/folk genre, and has had numerous television appearances and some radio play throughout Canada, USA, Europe, and Australia. He has successfully hosted songwriting workshops in a variety of settings, from homeless shelters to corporate offices.

S102824 08:30–09:30

Primary Care Management of Celiac Disease Prise en charge de la maladie coeliaque en contexte de soins primaires

Rick Ward, MD, CCFP, FCFP, Canmore, AB 718AB MTCC

Learning Objectives 1. list the clinical situations where celiac disease should be suspected 2. distinguish between celiac disease and other kinds of gluten intolerance 3. test and refer appropriate patients for further evaluation, and provide advice on diet therapy and monitoring Description: Celiac disease is an under-recognized, common condition in primary care that is associated with several important conditions. As well, a growing number of patients present with self-declared “gluten intolerance.” This practical, interactive session—developed with input from family physicians, family physicians with celiac disease, a gastroenterologist, and patients—provides current evidence on celiac disease screening, investigation, and management principles.

Objectifs d’apprentissage : 1. de nommer les situations cliniques où la maladie coeliaque devrait être suspectée 2. de faire la distinction entre la maladie coeliaque et d’autres types d’intolérance au gluten 3. d’effectuer des analyses et orienter les cas appropriés pour une évaluation plus approfondie Description: La maladie cœliaque est une affection sous-diagnostiquée couramment rencontrée en soins primaires et associée à plusieurs affections importantes. En outre, le nombre de cas de soi-disant « intolérance au gluten » se multiplie. Cette séance pratique et interactive, élaborée en collaboration avec des médecins de famille, des médecins de famille atteints de la maladie cœliaque, des gastro-entérologues et des patients, traite des données probantes actuelles sur le dépistage, les tests et les principes de prise en charge de la maladie cœliaque.

S100473 08:30–09:30

ABCs of Pediatric Dermatology Christie Freeman, MD, CCFP, MSc, DipPDerm, Peterborough, ON HALL G MTCC

Learning Objectives: 1. recognize clinical presentations and utilize diagnostic tools to diagnose some common pediatric dermatology conditions seen in the office (eg, atopic dermatitis, perioral dermatitis, tine capitis, skin infections, guttate psoriasis) 2. communicate with parents and patients effectively about treatments 3. prescribe appropriate therapy based on evidence and the speaker‘s experience Description: Family physicians encounter skin conditions in the pediatric population with great regularity. Having an approach to both diagnosis and treatment is important to provide timely relief to these children and to reassure parents. Most of the treatment of pediatric skin conditions will be the responsibility of the parents so having effective handouts and communication strategies are keys to good outcomes. This presentation will looks at some common diagnoses, including atopic dermatitis, tinea capitis, perioral dermatitis, guttate psoriasis, pityriasis versicolor, and warts. Clinical photographs of these conditions and their complications will be shown along with a review of diagnostic procedures that can be done quickly in the office to aid with diagnosis. A review of treatments for these conditions, some evidence based and some pearls based on the speaker‘s experience, will be discussed.

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S100561 Opioid Tapering: Motivational interviewing through better listening 08:30–09:30 Lori Montgomery, MD, CCFP, Calgary, AB; Todd Hill, PhD, RPsych, Calgary, AB; Chris Spanswick, MB, ChB, FRCA, FFPMRCA 701B MTCC Learning Objectives: 1. use basic motivational techniques to introduce the idea of an opioid taper 2. practise motivational skills in helping a patient to plan a taper 3. troubleshoot potential barriers to a medication taper Description: We are all accustomed to hearing calls for caution when prescribing opioids, but what do you do when you inherit a patient on high doses of opioids, or a patient for whom you believe opioids have ceased to be useful? The prescription pad is sometimes the least important tool to help these patients. This workshop will outline motivational interviewing and other clinical tools to help patients make changes in the ways they use opioids.

S101471 08:30–09:30

Enhancing Patient Education in Your Practice Jessica Dwyer, BSc, St. John‘s, NL; Cathy MacLean, MD, CCFP, FCFP, St John‘s, NL 713B MTCC

Learning Objectives: 1. describe and address challenges encountered by family physicians in educating patients 2. employ patient education techniques to meet patient literacy needs 3. define strategies to enhance patient education encounters throughout the office environment and beyond Description: With a shift toward more patient-centred care and continuous advances in health technology, the extent of patients‘ knowledge and involvement in their own health care must increase for the purpose of self-management, informed consent, shared decision making, and patient engagement. With this evolution away from paternalism and toward patient-physician partnership, family physicians must depend on much more than printed patient education materials (PEMs) in their offices to convey additional information that cannot always be covered in a short office visit. Through researching health literacy and surveying the needs of patients in family practice clinics, this session will disseminate best practices related to patient education in the office setting. Through short case presentations, using brainstorming and small group work, we will address each of the three objectives. From a quality improvement project, the D-O-C-E-R-E method was developed to evaluate the PEMs currently used in practice. This method will be shared and participants will actively engage in using this approach to enhance their own practices. Using the D-O-C-E-R-E approach, participants of this session will be guided through the critical appraisal of various examples of PEMs currently in circulation. This demonstration will show participants how to assess health education tools—Display, Obtainability, Consistency, Effectiveness, Readability, and Explanation— to ensure their quality and appropriateness for their family practice. Empowering current and future family practitioners to be more cognizant of the challenges, techniques, and education strategies they employ with their patients may improve patient engagement and involvement in self-management. In small groups, chronic disease management cases will be used to demonstrate additional strategies for enhancing patient engagement, including the use of technology and community resources.

S101696 08:30–09:30

Adolescents en centres jeunesse : Comment évaluer la santé des vulnérables parmi les vulnérables?

Youth in Custodial Facilities: Vulnerables among vulnerables

Yves Lambert, MD, CCMF, FCM, Longueuil, QC; Manon Duchesne, MD, CCMF, La Sarre, QC 713A MTCC — Small group interactive workshop – limited seating.

Description: L‘atelier est dérivé des résultats d‘une recherche sur les problèmes de santé des adolescents hébergés en Centre de réadaptation (CR), sur leur prise en charge et les besoins de soins et services non-comblés. En 2012, 2791 adolescents étaient hébergés dans un CR, soit pour des troubles du comportement, négligence ou maltraitance. Ces problématiques sont associées à des atteintes psychologiques, physiques, sociales, développementales. De plus, ces adolescents cumulent plusieurs facteurs de risque pour la santé liés à leurs antécédents et mode de vie. Compte tenu de l‘organisation du système de santé Québécois, on pouvait croire que les besoins de santé et l‘utilisation des services seraient différents de ce qu‘on retrouvait dans la littérature majoritairement américaine, en l‘absence de données québécoises comparables. En 2003, l‘ACJQ avait demandé au Regroupement des médecins en CR de produire un outil soutenant l‘évaluation des problèmes de santé. De plus, pour les infirmières et le personnel psychosocial, il apparaissait important de pouvoir prioriser des situations, le soutien infirmier et davantage les effectifs médicaux étant fréquemment limités dans certaines

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Objectifs d‘apprentissage : 1. décrire l‘état de santé des jeunes hébergés en Centres jeunesse 2. présenter les caractéristiques particulières de cette clientèle ainsi que des indices de complexité/sévérité de leurs besoins en matière de santé ainsi que de leurs besoins en matière de services 3. s‘approprier un outil d‘évaluation adapté à cette clientèle hautement vulnérable

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE régions. Nous proposons une grille d‘évaluation qui repose sur les résultats de la recherche. À part les éléments communément retrouvés, nous mettrons en lumière les questions qui sont ressorties de la recherche, leur pertinence ainsi que leur valeur ajoutée. Certains éléments dont les variables construites sur les événements adverses et le sommeil, permettent d‘établir, avant même l‘entrevue médicale, le niveau de risque de maladies aigues et chroniques, la « probabilité » de facteurs de risques, etc. Plusieurs sociétés savantes recommandent de faire une évaluation globale des jeunes à l‘admission au CR. Notre étude en confirme la pertinence au bénéfice de la santé du jeune mais aussi du processus de réadaptation. De plus, notre étude pointe vers plusieurs dimensions qui souvent sont perçues de moindre importance dans le cadre d‘une évaluation médicale usuelle. C‘est sous la forme d‘une interaction entre les participants et les présentateurs, mais aussi entre les données de la recherche et la grille d‘évaluation, que nous proposons à la fois le questionnement sur les besoins de santé de ces jeunes très vulnérables, et l‘appropriation des outils développés.

Learning Objectives: 1. describe the health of teenagers in youth custodial facilities 2. discuss the special characteristics of these youths and complexity/severity of their health needs as it relates to their services needs 3. discuss a grid especially developed for the health evaluation of these adolescents Description : The workshop is derived from the results of a study on the health problems of youth in custodial facilities, the management of these problems and unanswered health needs and services. In 2012, 2791 adolescents had been in custodial facilities in Quebec, mainly for behavior problems but also neglect and abuse: these are associated with physical, psychological, social and developmental problems. Moreover, these adolescents present many health risk factors in relation to their lifestyle and their own or family past history. Considering the organization of the Quebec health system, we could expect the health needs and use of services would have been different from what the literature reports, especially from the US, although without comparable data from Quebec. In 2003, the ACJQ had asked the Association of MD in custodial facilities to develop a tool to support the evaluation of health problems. Also, for the nurses and psychosocial staff in those facilities, it was important to set priorities for some health situations, nursing support and worse, access to physicians, being often limited in some regions.

We propose a health evaluation grid supported by the study results. Apart from commonly found items in such a grid, we will discuss items and questions that arise from the research, their pertinence and added value. Certain items like composite variables on adverse events or sleep problems, even before the health interview, establish the level of risky behaviors, and the chances of having acute or chronic diseases.

Many professional societies recommend a global health evaluation of youth admitted in custodial facilities. Our study shows the benefit of such an evaluation as well as its benefit for the psychosocial readaptation process. Our study also highlights some dimensions and items often perceived as less important when performing a routine medical evaluation. The workshop proposes an interaction between participants and the animators, using the relation between study results and the evaluation grid, reflecting on the health needs of youth in custodial facilities and the appropriation of the evaluation tool.

S102116 08:30–09:30

How to Turn Your Quality Improvement Project Into Research Christine Soong, MD, MSc, CCFP, Toronto, ON; Vandad Yousefi, MD, CCFP, Vancouver, BC 710 MTCC

Learning Objectives: 1. recognize the difference between quality improvement and research 2. use improvement science when designing quality improvement projects 3. apply research methodology to evaluate quality improvement projects Description: Family physicians are increasingly participating in quality improvement (QI) projects in the primary care setting. Designing a QI project with scientific rigour and evaluative design is necessary to determine efficacy of the intervention and to disseminate results within the scientific community. This session aims to describe the differences between QI and traditional research. Participants will learn how to design QI projects while incorporating evaluative design.

S102141 Don‘t Just Teach It – Share It: Teaching behaviour medicine using online resources 08:30–09:30 William Watson, MD, CCFP, FCFP, Toronto, ON; Allison Mullin, MA, Toronto, ON; Abbas Ghavam-Rassoul, MD, CCFP, FCFP, Toronto, ON 703 MTCC Learning Objectives: 1. discover DFCM Open modules and other resources and how they can be used in teaching behaviour medicine 2. use the modules during the workshop 3. relate and discuss new ideas in using online resources that can applied to participants‘ own programs Description: Many family medicine residency programs struggle with teaching behaviour medicine, especially around common clinical psychosocial problems such as depression, anxiety disorders, chronic pain, suicide, and addiction. Despite the value of behaviour medicine in family practice, teachers of family medicine often wonder if and how to teach it within a curriculum that is already crowded. This workshop will focus on how to effectively combine didactic learning in behaviour medicine with an experiential component, with particular attention given to free Web-based learning modules available online. These modules are case-based, using real family-practice scenarios to pose questions to the readers, and are designed to be used in small group learning or self-learning. They include evidence-based information on specific topics dealing with some of the common psychosocial aspects of behaviour medicine in family practice. This workshop will be of particular interest to those involved in teaching behaviour medicine to family medicine residents. In the spirit of sharing information, participants will be invited to share resources and strategies that have worked in their own programs.

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S102819 Prison Health Educational Opportunities for Medical Students and Residents 08:30–09:30 Margaret (Peg) Robertson, MD, CCFP, Kingston, ON; Josiane Cyr, MD, CCMF, Montreal, QC; Nader Sharifi, BSc, MD, CCFP, ABAM, CCHP, Surrey, BC; Fiona Kouyoumdjian, MD, CCFP, PhD, Hamilton, ON; Ruth Elwood Martin, MD, CCFP, FCFP, MPH, Vancouver, BC 715B MTCC— Small group interactive workshop – limited seating.

Learning Objectives: 1. review CanMED-FM competencies and roles that prison health educational opportunities can foster for learners 2. discuss the variety of prison health educational opportunities that are currently offered in undergraduate and postgraduate programs in Canada 3. network with others who are interested in fostering prison health educational opportunities Description: Incarcerated men and women represent an underserved and vulnerable population that suffers vast health inequities, when compared to the general population, with a high prevalence of mental illness and communicable disease. Therefore, Canadian prisons provide unique learning and invaluable service opportunities for medical students, residents, and physicians. We will describe varied undergraduate and postgraduate prison health educational programs in Canada. We will discuss the impacts of prison health experiences on learners, including the development of competencies in communication, health promotion, empathy, and reflective practice. Additionally, we will discuss ways that prison health residency electives and prison clinical practice provide opportunities for personal and professional growth. We will also explore ways that workshop participants might consider initiating prison health educational programs in their local correctional institutions. This workshop will discuss health issues of the prison population, while also promoting opportunities for meaningful education, advocacy, and personal growth.

S102863 08:30–09:30

Adults With Intellectual Delay in the Primary Care Physician‘s Office: Understanding intellectual delay

Donna Lougheed, MD, FRCPC, Ottawa, ON; Meg Gemmill, MD, CCFP, Kingston, ON 501 MTCC

Learning Objectives: 1. identify and understand the four levels of intellectual delay and their associated cognitive impairment 2. recognize when to assess for capacity to consent or refuse treatment 3. use an identification tool for patients with suspected mild intellectual disability and arrange further assessments and community supports Description: How can a primary care physician identify adults with intellectual delay in the office? This session aims to give participants an understanding of functional impairment and simple office techniques for assessment. We review implications for the care of patients, including when to assess for capacity to consent, using case studies and videos. We will also present a new identification tool for patients with suspected mild intellectual disability, along with preliminary research on its use in primary care.

S120354 08:30–10:15

So You Think You Can Research? Resident research projects Andrea Doxey, Manager, Continuing Professional Development, Ontario College of Family Physicians, Toronto, ON 716A MTCC

Learning Objectives: 1. examine current research in family medicine developed by top residents in Ontario 2. identify latest research from residents across Ontario and determine how to incorporate findings into everyday practice

S100477 12th EBM Teachers‘ Meeting 08:30–10:45 Roland Grad, MD, MSc, FCFP, Montreal, QC; Cameron Ross, MD, CCFP, Chilliwack, BC; David Chan, MD, CCFP, FCFP, Hamilton, ON; Inge Schabort, MB ChB, CCFP, Hamilton, ON humber room – intercontinental hotel

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Description: This is a showcase of the most highly rated, practical research or scholarly projects developed by our future leaders in family medicine—the residents from the class of 2015. In this 90-minute session, each resident will be given 10 minutes to present his or her research, followed by a question-and-answer period. Come out and support your former residency program and support our future innovators as they present their award-winning projects. A winner among winners will be voted on following the session.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. promote collaboration among EBM educators 2. raise awareness of individual successes with respect to education for evidence-based practice 3. share advances in instructional methods that can promote evidence-based practice Description: The objective of this meeting is to promote collaboration among EBM (evidence-based medicine) educators. In the past, this meeting of the EBM teachers group has been filled with presentations that provided a valuable starting point to realize this objective.

S101045 08:30–10:45

Mindfulness in Medical Education Shirley Schipper, MD, CCFP, Edmonton, AB 709 MTCC

Learning Objectives: 1. describe mindfulness in the context of medical education from the perspective of a family doctor 2. understand the existing programs and curriculum innovations related to mindfulness practice 3. relate practising mindfulness to teaching, learning, and life as a family doctor Description: Mindfulness is a new buzzword for many educators of medical students and residents. It‘s not just reflective practice, or meditation. What is it? Why does it matter? Aren‘t I already doing this? If you‘re like most medical educators, more on the mindless side when it comes to this topic, come learn about this “new” thing. I‘ll delve into the evidence behind it, the use of mindfulness in medical programs, and the applications to teaching and learning during this session.

S102145 08:30–10:45

Métasupervision entre collègues : l‘intégrer à nos journées surchagées Lyne Ménard, MD, CCMF,FCMF, New Richmond QC; Sophie Galarneau, MD, CCMF, Montreal, QC 705 MTCC

Objectifs d‘apprentissage : 1. se familiariser avec le concept de métasupervision.

2. pratiquer la metasupervision à l‘aide d‘une grille/outil facilitant la rétroaction entre collègue.

3. discuter de son application concrète comme outil de développement professoral local et continu.

Description : Cet atelier s‘adresse tant aux médecins superviseurs qu‘aux responsables locaux de développement professoral et aux directeurs locaux de programme. La métasupervision (ou supervision du superviseur) est une façon concrète et pratique de développer les compétences en supervision clinique autant pour les nouveaux enseignants que ceux d‘expérience. Un outil (grille d‘évaluation) pour faciliter la métasupervision vous sera proposé. Les différentes occasions de l‘utiliser de façon informelle entre collègues ou lors d‘une activité formelle de métasupervision seront discutées et l‘expérience de métasupervision des animatrices sera présentée. L‘utilisation de la grille sera pratiquée à l‘aide de jeux de rôles en trios. Les commentaires et suggestions des participants pour améliorer cette grille seront les bienvenus.

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S96520 09:45–10:15

All Chronic Pain Is Not the Same: Making an accurate pain diagnosis Ruth Dubin, PhD, MD, CCFP, FCFP, DCAPM, DAAPM, Kingston, ON 701B MTCC

Learning Objectives: 1. formulate an accurate pain diagnosis (above and beyond ”chronic non-cancer pain”) 2. perform a focused chronic pain exam to detect myofascial, neuropathic, mixed, and widespread pain 3. provide patient education and treatment suggestions specific to the underlying pain condition Description: This presentation will cover aspects of one patient‘s chronic pain management over time. We will review the case of a 37-yearold construction worker with chronic low back pain as he is managed by his primary care provider. Elements of a pain-focused history and physical exam will be discussed and demonstrated. These skills will equip participants to make more accurate pain diagnoses. The role of central sensitization in the transition from regional to widespread pain will also be reviewed. Determining whether pain is myofascial, nociceptive, mixed, or neuropathic can potentially lead to more effective treatment options for many patients. This talk will reinforce why you, with your comprehensive and continuing understanding of this patient‘s bio-psychosocial milieu, are the most important health care provider for your patients who are living with chronic pain.

S96986 10:15–10:45

Making It Real: Function and goal setting in a chronic pain patient Lydia Hatcher, MD, CCFP, FCFP, Ancaster, ON 701B MTCC

Learning Objectives: 1. identify the long-term consequences of chronic pain on patients physically, socially, and economically 2. describe the inherent issues and barriers associated with the effective management of chronic pain in primary care 3. provide patient education and treatment suggestions using functionality and goal orientation Description: This presentation will cover aspects of one patient‘s chronic pain management over time. We will review the case of a 37-yearold construction worker with chronic low back pain as he is managed by his primary care provider. You will gain comfort explaining that pain is best managed when the doctor and patient together understand what the goals for treatment are. You will learn new skills to be able to work with patients to improve their function. These skills will equip participants to better manage their pain patients. This talk will reinforce why you, with your comprehensive and continuing understanding of this patient‘s biopsycho-social milieu, are the best equipped health care provider for your patients who are living with chronic pain.

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LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S100869 09:45–10:15

The Cancer Journey: What primary care providers need to know Edward Kucharski, MD, CCFP, Toronto, ON; Lisa Del Giudice, MD, CCFP, Toronto, ON 401 MTCC

Learning Objectives: 1. describe the cancer journey: prevention, screening, diagnosis, treatment, survivorship, and end-of-life 2. describe the role of primary care providers in the cancer journey 3. list the guidelines, programs, tools, and resources available to support primary care providers and their patients with a focus on Ontario-specific information Description: Primary care providers have a crucial role in cancer care as they support patients and families throughout the entire cancer journey.

Two in five Canadians will be diagnosed with cancer in their lifetime and one in four will die of cancer (Canadian Cancer Society, 2013). Fortunately, more people are surviving and living longer with cancer. This interactive session will review the role of primary care providers in the cancer journey, including prevention, screening, diagnosis, treatment, survivorship, and end-of-life care. The emphasis will be on Ontario-specific guidelines and tools that are new, up—to—date, and relevant. The Cancer Journey presentation will focus on ”pearls” and resources that primary care providers can use in their everyday interactions with patients and families. For example: Prevention: smoking cessation, tanning beds, HPV vaccine; Screening: Ontario—specific guidelines & appropriate follow-up, new programs such as the High Risk OBSP, and practical individualized tools for MDs, like the Screening Activity Reports (SARs); Diagnosis: focus on Diagnostic Assessment Programs (DAPs)—rapid access programs for patients with suspicious lung, colorectal, and breast findings and symptoms; Treatment: practical resources for primary care providers to support patients—CCO‘s Symptom Management Guides (SMGs); End-of-Life Care—resources for both patients and practitioners including SMGs and advanced care planning; Recovery/ Survivorship-–tools to allow primary care providers the ability to follow up and care for patients who have survived cancer

S101338 10:15–10:45

Moving Forward After Cancer: Cancer follow-up care for the family physician Jeff Sisler, MD, MClSc, CCFP, FCFP, Winnipeg, MB 401 MTCC

Learning Objectives: 1. define the survivorship phase of cancer, and empathize with the common concerns patients have in this phase 2. describe with examples the four domains of care that should be addressed by the FP in cancer follow-up care 3. list key activities in the follow-up care of breast and colorectal cancer survivors Description: Family doctors are being asked to play a larger role in the follow-up care of their cancer patients who have finished curative-intent therapy. For many patients, cancer and its aftermath constitutes a chronic disease, and FPs and their teams need an approach to this care that builds on their expertise in managing other chronic diseases. Like post-MI care, cancer follow-up is also an opportunity for the primary care team and patient to work together to enhance health and rehabilitation and reduce the risk of recurrent disease. This presentation will offer FPs a helpful framework for any follow-up cancer visit that builds on four domains of care: prevention of new and recurrent cancer through health promotion; surveillance for cancer recurrence and new cancers; intervention for consequences of cancer and its treatments; and coordination of care with other providers. In addition, more detailed information about follow-up care for breast and colorectal cancer patients will be presented.

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S102176 To Screen or Not to Screen for Prostate Cancer With the PSA Test: 09:45–10:15 Deciphering the evidence and exploring the controversy Dépister ou ne pas dépister le cancer de la prostate à l'aide du test de l'APS : déchiffrer les données probantes et explorer la controverse

Neil Bell, MD, SM, FCFP, Edmonton, AB; James Dickinson, MBBS, PHD, CCFP, FRACGP, Calgary AB 718AB MTCC

Learning Objectives: 1. understand recent Canadian and US guideline recommendations on screening for prostate cancer with the PSA test 2. describe the natural history and epidemiology of prostate cancer and the potential benefits and harms of screening for prostate cancer 3. be able to engage in informed decision making with patients on screening for prostate cancer with the PSA test Description: Background: Prostate cancer (PCa) is the most commonly diagnosed non-skin cancer in men and the third-leading cause of cancerrelated death among men in Canada. Screening for PCa with the PSA test remains controversial and primary care physicians have been provided conflicting recommendations on the benefits and harms of screening for PCa with the PSA test. Objectives: To develop sufficient understanding of the natural history/epidemiology of PCa and the potential harms and benefits of screening for PCa to undertake informed decision making with patients on screening for PCa with the PSA test. Audience: Practising family physicians, residents, and students. Session Description: 1) Review recent Canadian and US guideline recommendations on screening for PCa with the PSA test. 2) Understand the key points of PCa and PCa screening: a) The natural history/epidemiology of PCa including the incidence and prevalence of PCa, risk factors such as age, race, and family history. Discussion will also include the changes in the incidence and mortality of PCa after introduction of the PSA test in Canada and other countries. b) Review the PSA test including threshold levels, false positives, and overdiagnosis. 3) Explore the evidence and areas of controversy on the use of the PSA test in screening for PCa: a) Review the evidence from major RCTs and observational studies on benefits and harms of screening with the PSA test and discuss areas of controversy that have led to conflicting recommendations on screening with the PSA test. b) Consider how the positive PSA test can lead to further investigation and treatment. c) Consider how patient values and preferences would influence the decision to screen for PCa with the PSA test. 4) Talk to patients about PCa screening: a) Explore the available tools and resources that inform discussion with patients. b) Participant opportunity to model the discussion with patient on harms and benefits of PCa screening with the PSA test. Session Outcome: Attendees will have an increased understanding of the benefits and harms of screening for PCa with the PSA test and be better prepared to discuss PCa screening with their patients.

Objectifs d‘apprentissage : 1. comprendre les récentes lignes directrices canadiennes et américaines sur le dépistage du cancer de la prostate par le test de l‘APS 2. décrire l‘histoire naturelle et l‘épidémiologie du cancer de la prostate et les bienfaits et méfaits potentiels du dépistage du cancer de la prostate 3. pouvoir prendre des décisions éclairées avec les patients quant au dépistage du cancer de la prostate par le test de l‘APS

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Description : Généralité : Le cancer de la prostate (CP) est le cancer non cutané le plus souvent diagnostiqué chez les hommes, et se classe au troisième rang des causes de décès lié au cancer chez les hommes au Canada. Le dépistage du CP par le test de l‘APS demeure controversé et les recommandations à ce sujet sont contradictoires. Objectifs : Acquérir une compréhension suffisante de l‘histoire naturelle/épidémiologie du CP et des méfaits et bienfaits potentiels du dépistage du CP afin de prendre des décisions éclairées avec les patients concernant le dépistage du CP par le test de l‘APS. Auditoire : Médecins de famille en pratique, résidents et étudiants.

Description de la séance : 1) Revoir les recommandations récentes des lignes directrices canadiennes et américaines sur le dépistage du CP par le test de l‘APS. 2) Comprendre les principaux éléments du CP et du dépistage du CP : a) L‘histoire naturelle/épidémiologie du CP y compris l‘incidence et la prévalence des facteurs de risque tels que l‘âge, la race et les antécédents familiaux. La discussion touchera aussi à la variation de l‘incidence et de la mortalité liées au CP après l‘introduction du test de l‘APS au Canada et dans d‘autres pays. b) Étudier le test de l‘APS, y compris les valeurs seuils, les faux positifs et le surdiagnostic. 3) Explorer les données et les controverses quant au test de l‘APS dans le dépistage du CP : a) Examiner les données tirées d‘essais randomisés et contrôlés et d‘études d‘observation majeurs portant sur les bienfaits et les méfaits liés au dépistage par le test de l‘APS et discuter de la controverse ayant donné lieu à des recommandations contradictoires à ce sujet. b) Réfléchir à la façon dont un test positif de l‘APS peut entraîner d‘autres investigations et traitements. c) Réfléchir à la façon dont les valeurs et préférences d‘un patient influencent la décision quant au dépistage du CP par le test de l‘APS. 4) Parler aux patients du dépistage du CP : a) Explorer les outils et ressources disponibles qui éclairent la discussion avec les patients. b) Les participants auront l‘occasion de prendre part à la discussion avec un patient sur les méfaits et bienfaits du dépistage du CP par le test de l‘APS. Résultats de la séance : Les participants comprendront mieux les bienfaits et méfaits associés au dépistage du CP par le test de l‘APS et seront mieux préparés pour discuter du dépistage du cancer de la prostate avec leurs patients.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S102404 Optimizing Management of Pain in Correctional Facilities in Canada 09:45–10:15 Fiona Kouyoumdjian, MD, MPH, PhD, CCFP, FRCPC, Hamilton, ON; Ruth Dubin, MD, PhD, FCFP, DAAPM, DCAPM, Kingston, ON; Nader Sharifi, BSc, MD, CCFP, ABAM, CCHP, Surrey, BC 715B MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe components of the assessment of patients who present with chronic pain in correctional facilities 2. identify key Canadian resources for opioid and chronic pain management 3. list best practices with respect to management of opioids in patients who are detained or incarcerated Description: Chronic pain and substance use disorders are common in persons in custody in jails and prisons in Canada. Challenges of managing pain for these patients while they are in custody include limited time for assessment, limited therapeutic and pharmacological treatment options, potential for abuse or diversion of medications, and the absence of continuity of care between the community and the custodial facility. This session is intended for primary care physicians who are working or planning to work in correctional facilities, or who frequently manage pain in persons after their release from custody. We will discuss key principles in pain management in this population, and then facilitate a discussion with participants regarding cases of interest and barriers to care. We will aim to identify opportunities to improve pain management in correctional facilities, which we will share with the Prison Health Community of Practice for advocacy purposes.

S101394 When Mom Goes to Prison: Prison health best practices for maternal and newborn care 10:15–10:45 Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Ruth Martin, MD, CCFP, Vancouver, BC; William Ehman, MD, CCFP, Nanaimo, BC; Katherine Rouleau, MD, CCFP, Toronto, ON; Fiona Kouyoumdjian, MD, CCFP, Hamilton, ON; Janet Smylie, MD, CCFP, FCFP, Toronto, ON 715B MTCC— Small group interactive workshop – limited seating.

Learning Objectives: 1. review a prison clinical scenario based on real situation(s) that focus on maternity and newborn care and aboriginal health 2. identify evidence-based ”best practice” responses, which are included in national guidelines for the implementation of mother-child units in Canadian correctional facilities 3. describe how Canadian health care providers can be health advocates for maternal and newborn care, both inside correctional facilities and in the outside community Description: Throughout the world, incarcerated women tend to be young and of childbearing age, often lacking financial resources and unable to access mainstream education systems. In 2003, an estimated 20,000 Canadian children were separated from their mothers because of incarceration. In 2013, a BC Court ruled that separating newborns from their incarcerated mothers violated the Canadian charter. This interactive workshop will review a prison health clinical scenario, based on real cases, to discuss evidence-based ”best practices” in maternal and newborn care and aboriginal health. We will also explore ways that health care providers can engage in health advocacy for women and their children, both inside correctional centres and in the outside community. This workshop is designed for those with a special interest in prison health, but also for those who wish to understand better the impact of incarceration on women and their families.

S95441 09:45–10:45

Adolescent Sexual Health Update Aarti Kapoor, MD, CCFP, Toronto, ON 802AB MTCC

Learning Objectives: 1. use tips for speaking to youth, providing office environments that empower them with accurate knowledge to take control of their lives/ bodies 2. recognize and employ knowledge of sex worker screening, sexual assault, post-abortion care, and intimate partner violence in discussions with youth presenting to the office 3. provide youth with knowledge on online dating/Internet safety, buying condoms online, anonymous/home HIV testing, and age of sexual consent Description: Recently, Canadian youth have been frequently featured in the news. Unfortunately, headlines vary from bullying-induced suicide, sexual assault, and intimate partner violence to a resurgence of syphilis, increased rates of new HIV cases, and antibiotic-resistant gonorrhea. It is becoming increasingly apparent that pre-teens, teenagers, and young adults experience many unique changes during the time of development known as “adolescence.” However, exposure to this population during medical training can be sparse. This lecture will aim to provide community practitioners with up-to-date information to meet the growing sexual health needs of youth in the community. Practitioners will leave feeling comfortable providing open office environments to empower youth with knowledge. They will learn to manage rarely taught sexual health topics relevant to youth in their communities such as LGBTQ/sex worker screening, sexual assault, post-abortion care, and an approach to intimate partner violence. Complementing Ontario‘s proposed new sexual health school curriculum, practitioners will also be taught to provide youth with the most up-to-date knowledge on online dating/Internet safety, two-minute HIV testing, home oral HIV testing, and age of sexual consent. Session participants will leave having developed the ability to recognize and appropriately address sexual health issues specific to youth that present to their own practices, preventing the progression to chronic illness in the future. fmf.cfpc.ca

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S100005 09:45–10:45

Sex and Birth Control: Are they related?

Ellen Wiebe, MD, FCFP, Vancouver, BC 701A MTCC

Learning Objectives: 1. name the possible sexual side effects of hormonal, intrauterine, and barrier contraception in order to help patients choose contraception that does not interfere with sexual pleasure 2. describe the different motivations to have sex and to have children in order to help patients avoid unintended pregnancies while enjoying sex 3. use good questions when asking about sexual side effects Description: This is an interactive session, using case histories with discussion as well as a presentation of evidence from the literature. Cases will involve sexual side effects of contraceptives, decreased motivation for sex being related to decreased motivation to contraception and unplanned pregnancy resulting from the conflict between the physiological drive to reproduce and logical life planning. The emphasis of this workshop will be practical aspects of family planning involving talking with our patients about sex and birth control.

Although there is evidence that sexual side effects cause much of the discontinuation of hormonal contraception, this problem is infrequently discussed in family doctors‘ offices. In this session we will discuss problem solving these issues: finding contraception that does not interfere with sexual pleasure and helping our patients avoid unintended pregnancies while continuing to enjoy sex.

S101803 09:45–10:45

Mining for Data Gold: How to recycle imperfect EMR data into valuable and useful information Michelle Greiver, MD, MSc, CCFP, FCFP, Toronto ON; Babak Aliarzadeh; Marjan Moeinedin 710 MTCC

Learning Objectives: 1. learn to work with imperfect data: limitations and how to maximize the value of what is currently available 2. discover additional helpful tools and resources and how to access them 3. discuss what can be done today to improve the quality of their EMR data Description: EMR data are problematic. Quality can be poor and free text/unstandardized data are often difficult to query. However, many family physicians and primary care teams have already been able to derive significant value from currently existing data; these data can be used to measure, monitor, and improve care provided to patients. This can involve activities such as querying data in EMRs (“front end data”), supplementing EMR data with external information ( e.g, Ontario‘s provincial Screening Activity Report, SAR), or participating in projects such as Canadian Primary Care Sentinel Surveillance Network (CPCSSN) where cleaned/standardized EMR data and reporting software are returned to groups of physicians. CPCSSN has now built a significant and growing library of algorithms to clean EMR data, tested across multiple EMRs in Canada. Our EMR data is full of golden nuggets that can be mined today. We will discuss several practical approaches to using what is currently available, and discuss requirements and activities that can improve and increase data usage in primary care.

S101873 09:45–10:45

”What Gets Measured Gets Treasured”: Implementing clinical quality improvement initiatives that drive big results!

Shauna Wilkinson, BMgt, Calgary, AB 714AB MTCC

Description: Crowfoot Village Family Practice is a patient-centred medical home that has adopted a quality improvement method emphasizing empowerment, measurement, and supported change that drives clinical outcomes. This session will explore practical, recent examples of quality improvement initiatives that have resulted in achieving advanced access, reduced return visit rates, and reduced use of acute care services and which drive significant acute cost savings and enhanced patient and provider experiences. Our focus will be on the important components of change management and sustainability, no matter what the quality improvement initiative.

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Learning Objectives: 1. discover how to establish a core team responsible for driving change and determine ongoing measurement, tools, and tactics for innovation 2. discover how to involve, motivate, and empower your people and to create excitement that will drive improved clinical outcomes and experiences for your patients 3. discover methods to sustain momentum and excitement and to continue to improve beyond your goals

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S102229 09:45–10:45

Emergency Medicine Top 10 Articles to Change Your Practice Médecine d‘urgence : Les 10 meilleurs articles qui changeront votre pratique

Constance LeBlanc, MD, CCFP (EM), FCFP, MAEd, Halifax, NS; Mark Mensour, MD, CCFP (EM), FCFP, Huntsville, ON; Janet MacIntyre, MD, FRCPC, Halifax, NS HALL F MTCC Learning Objectives: 1. change practice in 10 areas based on the most up-to-date literature 2. translate the information into easy teaching bullets for teaching in the emergency department 3. effectively include cutting-edge literature, when applicable, to practice in the emergency setting Description: This session will include 10 six-minute reviews of recent, practice-changing articles from the emergency medicine literature. Five presenters will each present two articles. Implications, pitfalls, and legal issues, as well as the acceptability of not making these changes in emergency medicine practice, will be included for various clinical settings by each of the presenters. A template, developed by the primary presenter, will be used for all five presentations for that portion of this talk. This template provides structure for presenting articles from the literature efficiently and effectively. Presenters will also use the Katie Calculator Model from Dalhousie University CPD office (http://katie.dal.ca) in their presentations to provide both absolute and relative numbers in presenting the information to achieve balance. Discussion will include study bias, methods, results, NNT, NNH, and the application of this practice change in various settings. All speakers will remain available for informal discussion after the session.

Objectifs d‘apprentissage : 1. changer la pratique dans 10 domaines, en fonction des publications les plus récentes 2. traduire l‘information en points faciles à enseigner à l‘urgence 3. inclure efficacement les publications d‘avant-garde, le cas échéant, pour pratiquer dans un contexte d‘urgence Description : Cette séance comprend 10 revues de six minutes d‘articles récents tirés de publications sur la médecine d‘urgence qui changeront votre pratique. Cinq conférenciers présenteront deux articles chacun adaptés à divers contextes cliniques. Chaque conférencier parlera des répercussions, des pièges et des enjeux juridiques, de même que de l‘admissibilité de ne pas apporter ces changements dans la pratique de la médecine d‘urgence. Un modèle créé par le conférencier principal sera appliqué aux cinq présentations de cette portion de la séance.

Ce modèle permet de présenter de manière efficiente et efficace les articles des publications selon une même structure. Les conférenciers utiliseront aussi la calculatrice de signification clinique Katie (Katie Clinical Signification Calculator) mise au point par le bureau de DPC de l‘Université Dalhousie (http://katie.dal.ca) pour présenter des chiffres absolus et relatifs afin d‘équilibrer leur présentation. Les discussions traiteront de la partialité dans les études, des méthodologies, des résultats, du NPT, du NPN et de l‘application de ces changements de la pratique dans divers contextes. Tous les conférenciers participeront à une discussion informelle après la séance.

S102520 Using EMR Tools to Improve the Primary Care of Adults With Developmental Disabilities 09:45–10:45 Laurie Green, MD, CCFP (EM), Toronto, ON; Meg Gemmill, MD, CCFP, Kingston, ON; Andrea Perry, OT, Toronto, ON; Abigail Scott, BA, CHIM, Kingston, ON 501 MTCC Learning Objectives: 1. create an electronic cohort of adult patients with developmental disabilities in a family medicine practice 2. use EMR tools to improve patient-centred delivery of health care to adults with developmental disabilities 3. use EMR tools in the delivery of guideline-recommended primary care to adults with developmental disabilities Description: Pilot projects in Ontario have implemented tools in EMRs to support clinicians, residents, and teachers and quality improvement researchers in assessing and improving care for adults with developmental disabilities. The Health Care Access and Research in Developmental Disabilities Research Program in Ontario has demonstrated positive attitudes among clinicians toward providing care for such patients but less confidence in knowledge or skills. EMR-based tools can provide both “just-in-time” support at clinical encounters and also measurable outcomes for quality improvement programs. Both goals are expected to make practices more efficient for family physicians and more effective for this group of patients known to experience barriers in access to health care. Family physicians and staff from two pilot projects will demonstrate the tools and encourage participants‘ questions. Participants will be provided with hard copies and links to resources as well as with approaches they can use to adapt their own EMRs and practices.

S102586 09:45–10:45

Innovations in Digital Health Technology: Can they change your practice?

Amanda Condon, MD, CCFP, Winnipeg, MB; Rashaad Bhyat, MD, CCFP, Toronto, ON 716B MTCC

Learning Objectives: 1. list new digital health technologies and how they are being used in family medicine offices 2. compare barriers and benefits to use of these solutions in your office 3. measure outcomes of using digital health technologies in the care of your patients Description: New digital health technologies are being developed every day; these innovations are marketed as tools that will change our practice or improve the health of our patients. Are they just gimmicks or do they actually work? This session will review new health technologies, profile actual users of these innovations, and describe their use in supporting the concept of the Patient‘s Medical Home and their impact fmf.cfpc.ca

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on patients, office staff, and associated clinical outcomes. Some of the innovations include optimizing your EMR, implementing consumer health solutions (eg, electronic scheduling, e-visits), monitoring patients remotely, and using patient portals and integrated care plans.

S102751 09:45–10:45

Building Competencies in Care of the Elderly by Doing House Calls: How can we spread this?

Chase Everett McMurren, MD, CCFP, Toronto, ON; Sabrina Akhtar, MD, CCFP, Toronto, ON 703 MTCC

Learning Objectives: 1. identify three main competencies in care of the elderly with which family medicine learners struggle 2. outline resources available to family physicians for supporting the practice and teaching of home-based care 3. describe strategies for integrating home-based care into your family medicine teaching program Description: The need to develop innovative solutions to meet the growing demands of an aging population has been well established in the literature within both Canada and globally. Integrated home-based primary care (IHBPC) is a modern twist on the old-fashioned doctor‘s house call, and as a model of care is gaining attention of policy makers and providers as one way to meet increasingly complex health demands that are rendering a growing proportion of the population homebound. IHBPC is facilitated by interprofessional teams, which typically include family physicians alongside nursing, rehabilitation, pharmacy, and social work practitioners, who collaborate closely with community agencies. These home-based primary care programs have the following overall goals: to provide access to ongoing primary medical care; to maximize independence and function; to reduce emergency department and hospital admissions; to enhance patient safety and quality of life; and to link patients to supportive home-care services. IHBPC can improve patient and system outcomes, but the literature points to a lack of educational frameworks as one barrier to scaling up these programs across communities. Structured home-based primary care programs can increase family medicine trainees‘ exposure, skills, and positive attitudes towards doing house calls as future family physicians, and build competencies in care of the elderly. IHBPC for the frail elderly is a topic area rich with learning opportunities that stretch across family medicine educational competencies. Within several family medicine programs across the country, house calls are being integrated into family medicine teaching, and it would be beneficial for educators, teachers, and learners to share a consistent educational framework informed by evidence and best practices. In this workshop, we aim to review existent programs at work, and how skills in home-based primary care align with CanMEDs-FM objectives and competencies in care of the elderly, specifically the ”harder to teach” competencies in health system navigation and advocacy.

S102855 Teaching Advocacy in Primary Care: Fostering social accountability in medical learners 09:45–12:15 Kathleen Doukas, MD, CCFP, Toronto, ON; Karen Weyman, MD, CCFP, Toronto, ON; Nasreen Ramji, MD, CCFP, Toronto, ON; James Owen, MD, CCFP, Toronto, ON 707 MTCC Learning Objectives: 1. develop a framework for thinking about competency in advocacy and social responsibility 2. describe the impact of clinical experiences on advocacy 3. develop a practical curriculum design to teach advocacy to medical learners

S102882 09:45–12:15

Embodying Trust: Developing our senses for enhanced non-verbal communication in clinical practice Martina Kelly, MBBCh, MA, MICGP, FCRCP, CCFP, Calgary, AB; Lara Nixon, MD, CCFP, FCFP, Calgary, AB 711 MTCC

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Description: Social accountability is an attribute we strive to foster in our medical trainees, and falls within the CanMEDS–Family Medicine (FM) Health Advocate Role. It can be difficult to teach and evaluate given its abstract nature and broad scope. The CanMEDS-FM Health Advocate must respond to individual and community needs, identify the specific social determinants of health of individuals and populations served, and promote health. Family medicine preceptors must foster an interest and participation in advocacy among trainees in order to achieve competency in the advocate role, while simultaneously recognizing that many values, attitudes, beliefs, and behaviour in medicine are learned via a “hidden curriculum,” which must be explicitly addressed. Participants in this workshop will have an opportunity to discuss what it means to be an advocate and how this professional identity can be shaped by a variety of clinical experiences. Identifying marginalized populations within each participant‘s community of practice will be explored.

A model of curriculum delivery exposing students to vulnerable patients and providing students with the opportunity to further develop their role as an advocate will be presented and discussed. The workshop will aim to develop a curriculum for advocacy within each participant‘s professional setting, using a case-based approach to identify specific opportunities to foster social advocacy within medical trainees. Family physicians should recognize the value of mentoring, role modeling, and reflection in teaching social accountability and advocacy. As family medicine provides care for a variety of individuals and groups throughout the life cycle, advocacy as a core competency can and should be embedded in teaching opportunities for our medical trainees.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE Learning Objectives: 1. discover a series of physical exercises to enhance awareness of visual interpretation, listening, movement, and touch 2. develop awareness of these dimensions of communication in clinical practice 3. relate these experiences to concepts of trust and relationship-building in family medical practice Description: Most human interaction is non-verbal. Non-verbal communication is complex, encompassing a range of interactions (eg, body language, touch, gaze, proximity, and use of the environment), which impact how we build trust and relate to one another in clinical practice.

Traditionally the focus of communication skills training has been on verbal interaction. Less attention has been paid to our silent communication. This session aims to highlight the importance of non-verbal communication in day-to-day clinical practice by drawing on the concept of embodiment. Embodiment is the way individuals negotiate their everyday lives via their bodies and how they mediate, interpret, and interact with their physical and social environments, and will be demonstrated using theatre-based exercises to stimulate sensory awareness. This fun, interactive workshop begins with a brief overview of non-verbal modes of communication, stimulated by video clip analysis, followed by a series of theatre games and exercises designed to enhance listening skills, visual interpretation, and the use of touch to build trust in clinical interaction. After each exercise, participants will be asked to reflect on their learning from the activity and its relevance to clinical practice and medical education. We will consider how non-verbal messages can be encoded (generated) and decoded (interpreted). Throughout the workshop, collective themes will be charted and then summarized and fed back to the group for further discussion. We invite participants to attend ready for engagement (and recommend wearing comfortable clothing that allows movement), but participation in each exercise is optional.

S99546 10:15–10:45

Critical Drug Interactions That Family Doctors Should Know About Suzanne Singh, BScPhm, PharmD, RPh, Toronto, ON HALL G MTCC

Learning Objectives: 1. identify “high-alert” medications associated with clinically significant drug interactions in primary care 2. outline risk factors for the development of adverse effects from drug interactions 3. review strategies to avoid and manage common drug interactions in your practice Description: With so many medications available on the market, it is virtually impossible to remember every single drug interaction that may rear its ugly head. Help is on the way! This session will offer family doctors practical tips for how to identify, prevent, and manage drug interactions.

Didactic presentation and interactive case discussion will be used to outline which drugs are on the “naughty list” (ie, medications that are the most notorious for clinically important drug interactions), and also illustrate which patients may be the most vulnerable for experiencing an adverse outcome from a drug interaction. Various strategies highlighting how to avert and handle common drug interactions encountered in primary care will be reviewed.

S101679 10:15–10:45

Therapeutic Applications of Botulinum Toxin Type A (Botox®): An introduction for the family physician

Samuel Hetz, MSc, MD, Ottawa, ON 713B MTCC

Learning Objectives: 1. screen for and diagnose chronic migraine and hyperhidrosis in your family medicine office 2. understand the evidence for onabotulinumtoxinA in chronic migraine and hyperhidrosis treatment, and discuss the potential benefits with patients 3. describe the safety profile of onabotulinumtoxinA for chronic migraine and hyperhidrosis, and discuss risks and side effects with patients Description: The therapeutic applications of botulinum toxin (onabotulinumtoxinA—Botox®) continue to grow. Chronic migraine (CM) prophylaxis and axillary hyperhidrosis (HH) are two common therapeutic applications pertinent to family physicians. These conditions have a profound impact on patients‘ quality of life, productivity, and societal involvement. For example, studies have demonstrated that the disruptiveness of HH on daily activities is similar to that of rheumatoid arthritis and other chronic diseases. Managing CM and HH in the office setting can be challenging, yet treatment of these conditions using onabotulinumtoxinA is certainly within the scope of the family physician. Although not covered by provincial health plans, private health insurance usually funds onabotulinumtoxinA treatments if medically indicated.

CM is defined by the International Classification of Headache Disorder (ICHD) criteria while a consensus panel defines HH. The specific diagnostic criteria for CM and HH, diagnostic tests, as well as diagnoses that must be excluded prior to making a diagnosis of CM and HH, will be discussed in detail. Indications for when treatment with onabotulinumtoxinA is indicated will be discussed in detail. Evidence for onabotulinumtoxinA for both of these conditions is quite robust. The PREEMPT study, published in Headache in 2010, demonstrated that onabotulinumtoxinA was safe and effective for treatment of CM. For axillary HH, sweat rate decreased by as much as 97.7 per cent following onabotulinumtoxinA injection. Although considered ”off-label,” but widely accepted in medical practice, onabotulinumtoxinA is also used for both plantar and palmar hyperhidrosis. Detailed research will be presented during the session. Basic procedural technique for both CM and HH will be briefly discussed during the session. Potential risks and side effects of onabotulinumtoxinA treatment will be discussed in detail.

As well, common myths associated with onabotulinumtoxinA will be clarified. Participants will leave the session with a global understanding of onabotulinumtoxinA applications for CM and HH, which in turn will greatly benefit their patients.

S101360 11:15–11:45

Approach to Common Hand Injuries in the Family Practice and Emergency Room Setting Sanjay Azad, MS, FRCSEd, FRCSEd (Plastic Surgery), Thunder Bay, ON HALL G MTCC fmf.cfpc.ca

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Learning Objectives: 1. identify common hand injuries in the ER setting and family practice setting 2. evaluate and make appropriate and timely referrals of these common hand problems 3. effectively manage common hand injuries Description: Hand injuries are common in the family practice setting and in the emergency room environment. The injuries can range from simple to complex and timely management of these common problems is an issue. The presentation is aimed at primary physicians to facilitate better understanding of these problems including nail bed injuries, distal fractures, mallet fingers, common hand fractures such as boxer‘s fracture, and tendon injuries such as flexor and extensor tendons. Common operative approaches will be emphasized including use of Vicryl Rapide (dissolving sutures), long-lasting analgesia, and appropriate splintage with therapy. This would be extremely useful for remote rural settings and physicians working in ER.

S101948 11:15–11:45

Options, Options, Who Has the Options? Non-opioid treatments for chronic pain Bruce Hollett, MD, CCFP, St. John‘s, NL 701B MTCC

Learning Objectives: 1. educate patients on evidence-based treatment modalities for chronic pain 2. prescribe non-pharmacological and non-opioid pharmacological therapies for chronic pain 3. tailor treatment for specific pain conditions such as myofascial, neuropathic, mixed, and widespread pain Description: This presentation will cover aspects of one patient‘s chronic pain management over time. We will review the case of a 37-yearold construction worker with chronic low back pain as he is managed by his primary care provider. The ideal treatment of chronic pain comprises non-pharmacological treatments (eg, physiotherapy, counseling, self-management, exercise, meditation) and pharmacological modalities. This talk will focus on non-opioid treatments for chronic pain, which should ideally be used before opioid prescribing is considered.

S102435 11:45–12:15

Chronic Pain: Optimizing opioids, reducing risks Roman Jovey, MD, Mississauga, ON 701B MTCC

Learning Objectives: 1. assess and risk-stratify patients with chronic pain for opioid therapy 2. prescribe and monitor opioid therapy using universal precautions 3. document key outcome measures to demonstrate benefit Description: This presentation will cover aspects of one patient‘s chronic pain management over time. Various speakers will review the case of a 37-year-old construction worker with recurrent chronic low back pain as his primary care provider manages him. After a biopsychosocial assessment and an adequate trial of non-pharmacological and non-opioid medications, the primary care provider is considering a trial of long-term opioid therapy. This presentation will illustrate a practical, office-based process to optimize benefit and reduce risks, based on the Canadian Opioid Guidelines (2010). Topics will include how to assess and risk-stratify patients, starting and titrating opioids, managing common adverse effects, and structuring a follow-up strategy to document key outcomes of treatment.

Liz Grier, MD, CCFP, Kingston, ON; Brian Hennen, MD, CCFP, FCFP, Dartmouth, NS; Lori Kiefer, MD, CCFP, FRCPC, Toronto, ON 715B MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. discuss a prison clinical scenario focusing on palliative care and developmental disabilities, based on real situations that present in prison health 2. discuss evidence-based ”best practice” responses recommended for health care providers in the community 3. explore ways to advocate for best-practice palliative care and developmental disability care for people during their incarceration and following their release

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S102792 Prison Health Best Practices: Palliative care and developmental disabilities 11:15–11:45 Ruth Martin, MD, MPH, CCFP, FCFP, Vancouver, BC; Paolo Mazzotta, MD, CCFP, Toronto, ON;

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE Description: Incarcerated populations have a high prevalence of chronic conditions including developmental disabilities and cancer. In addition, incarcerated subgroups, such as the elderly, terminally ill, and those with developmental disabilities, have specific health concerns. Prison health practitioners often work in isolation without resources to guide their clinical decision making. This interactive workshop will review a clinical scenario, based on real situations faced by prison health practitioners, such as intractable pain, terminal illness, and developmental disabilities, including fetal alcohol spectrum disorder. We will discuss community-based best practices for these conditions and the logistics of using equivalent best practices inside Canadian correctional facilities. This session will be certified for Mainpro CPD credits.

Representatives from three Communities of Practice in Family Medicine (CPFM) will facilitate this workshop: Palliative Care, Developmental Disabilities, and Prison Health.

S100010 11:15–12:15

Helping Your Patient Cope With an Unplanned Pregnancy Ellen Wiebe, MD, CCFP, FCFP, Vancouver, BC 716B MTCC

Learning Objectives: 1. help patients explore their options when faced with an unplanned pregnancy 2. give specific resources to patients dealing with the religious or relationship issues related to unplanned pregnancies 3. give accurate information about the risks of abortion compared to birth Description: We will share information about abortion in Canada so you can give the best information to your patients. We will then go through some typical cases of unplanned pregnancy in family practice. Doctors have professional and personal obligations as well as beliefs and facts.

Patients arrive with personal and external issues. We will talk about good questions to ask women and their partners to help them clarify their issues and make the best decisions. We will share the best ways to address particular concerns such as risk of infertility and depression and the effect of an abortion or unplanned child on the relationship.

S101006 11:15–12:15

A Clinical Algorithm for the Detection, Monitoring, and Management of Chronic Kidney Disease (CKD) in Primary Care

Allan Grill, MD, CCFP, FCFP, Toronto, ON; Scott Brimble, MD, MSc, FRCP(C), Hamilton, ON 401 MTCC

Learning Objectives: 1. identify which patients in a typical family practice are at higher risk for chronic kidney disease (CKD) 2. clarify which investigations to order for patients at high risk for CKD and how to interpret the results 3. review and receive a practical clinical algorithm that outlines the role of the primary care practitioner in managing patients with CKD and the criteria for appropriate referral to nephrology Description: Chronic kidney disease (CKD) affects approximately two million Canadians and is a recognized risk factor for all-cause mortality. Patients that progress to end-stage renal disease experience significant morbidity and a reduced quality of life. Primary care providers (PCPs) can play an important role in the early detection and prevention of progression of CKD. The 2013 Kidney Disease Informing Global Outcomes (KDIGO), Canadian Hypertension Education Program (CHEP), and the Canadian Diabetes Association CKD guidelines were reviewed for relevant content to produce, through an iterative process, a clinical algorithm. The Ontario Renal Network (ORN) provides leadership and strategic direction to effectively deliver renal services in a coordinated manner. One of its key strategies is to improve early detection of CKD at the primary care level. It is anticipated that this algorithm will empower PCPs with confidence to become more aware of CKD management issues in a consistent evidence-informed manner. By the end of this talk, participants will be able to (1) identify which patients are at higher risk for CKD; (2) understand which investigations to order and how to interpret the results; (3) manage CKD and its associated cardiovascular comorbidities; and (4) appropriately select which patients need to be referred for nephrology consultation.

S101286 11:15–12:15

Managing Attention Deficit Disorder in Adults in Your Office Nick Kates, MBBS, FRCPC, MCFP (Hon), Dundas, ON 713B MTCC

Learning Objectives: 1. recognize the presence of symptoms of ADHD during an office visit 2. understand the diagnostic criteria for ADHD in adults and its differential diagnosis 3. use the commonly prescribed medications for treating ADHD, and know their indications Description: Up to 5 per cent of all adults may have symptoms of attention deficit disorder but the majority of these problems remain undetected and untreated. Primary care remains the ideal and in many instances the only place for recognizing these problems and initiating treatment as most adults with ADHD will be seen in primary care, although rarely with attention or hyperactivity as the identified reason for a visit. This workshop reviews the prevalence of ADHD in primary care and the many different ways it can present including with other mental health or addiction problems. It outlines the diagnostic criteria for ADHD in adults and how to assess for its presence during an office visit, including the use of screening instruments. It then describes an integrated approach to management that includes education, support, providing structure, involving other family members, and medication. It summarizes the different kinds of short- and long-acting medications, their indications, side effects, and similarities and differences, and how to initiate treatment.

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S124065 11:15–12:15

Vulvar Dilemmas Margaret Burnett, MD, CCFP, Winnipeg, MB 714AB MTCC

Description: Vulvar diseases don’t have to be a pain! Three interesting cases will illustrate the differential diagnosis and treatment of acute and chronic vulvar pain. By the end of the session, the participants will recognize and differentiate vulvar dystrophy, carcinoma of the vulva, genital ulcer disease and vulvodynia. The “when, where and how” of vulvar biopsy will be addressed. Strategies for symptomatic treatment and specific therapy will be discussed. The aim of the session is to demystify vulvar diseases and to provide the participants with a strategic approach to the patient presenting with vulvar pain.

S101665 11:15–12:15

Simplified Lipid Management: A truly primary care guideline Gestion simplifiée des lipides : Une directive de soins vraiment primaire Michael Allan, MD, CCFP, FCFP, Edmonton, AB HALL F MTCC

Learning Objectives: 1. understand why to screen patients for cardiovascular risk rather than simple lipid levels 2. learn how to target therapy (lifestyle, statins, and others interventions) based on risk level and gain skills in how to discuss risks and benefits with patients 3. apply simple modifications to practice, like non-fasting lipids and reduced monitoring, to enhance compliance and ease for patients and care-providers Description: Family physician representation on clinical practice guidelines is sorely lacking and, in many cases, recommendations are not based on evidence or real application to primary care. The recently completed “Simplified Lipid Pathway for Primary Care” included a full evidence review, involved mostly family physicians, and had no industry, and the majority of participants had no conflict of interests.

In this unique guideline, the focus has moved from lipid testing to risk assessment. We will review how we can reduce the frequency of lipid testing to every five years and, once a statin is started, perhaps never test again. Interventions like lifestyle and statins should be targeted at risk instead of surrogate markers. Simplified elements include using non-fasting lipids, reduced monitoring of lipids, removing lipid targets, removal of interventions with weak evidence, and little to no laboratory monitoring for CK/LFTs. Useful tools for discussion with patients will be presented and learners will be able to describe risk to patients as well as outline the benefits of treatment. These will include pamphlets from the guideline as well as risk estimation tools and examples of discussions with patients.

In all cases, we will present the evidence to support these recommendations and outline the specific approach to certain subgroups like diabetics, the elderly, and those with renal impairment. We hope we can show how a family physician-run clinical practice guideline can both improve and simplify care while actively involving patients in true shared and informed decision-making.

Objectifs d‘apprentissage : 1. comprendre comment dépister le risque cardiovasculaire plutôt que le simple taux de lipides chez les patients 2. apprendre comment cibler le traitement (mode de vie, statines et autres interventions) en fonction du niveau de risque et acquérir les compétences sur la façon de discuter des risques et bienfaits avec ses patients 3. appliquer des modifications simples de la pratique, telles que le taux de lipides non à jeun et la réduction de la surveillance afin d’améliorer l’observance du traitement et de faciliter la vie des patients et des fournisseurs de soins

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Description : L‘absence de représentation des médecins de famille dans les comités de lignes directrices de pratique clinique est criante et dans certains cas, les recommandations ne sont pas fondées sur des données probantes ni sur l‘application réelle en soins primaires. Le projet récemment terminé « Simplified Lipid Pathway for Primary Care » inclut une revue complète des données probantes, a fait participer surtout des médecins de famille, n‘est pas commanditée par l‘industrie et la majorité des participants étaient libres de tout conflit d‘intérêts. Dans ces lignes directrices uniques, on passe des tests lipidiques à l‘évaluation du risque. Nous examinons la façon dont on peut réduire la fréquence des tests lipidiques tous les 5 ans, et une fois qu‘une statine est instaurée, peut-être ne jamais refaire le test. Les interventions telles que le mode de vie et les statines doivent cibler le risque plutôt que les marqueurs de substitution. Les éléments simplifiés sont : faire des tests lipidiques non à jeun, réduire la surveillance des lipides, éliminer les cibles lipidiques et les interventions fondées sur des données de faible qualité et peu, voire pas de surveillance en laboratoire de la créatinine kinase/tests de la fonction hépatique. Des outils utiles de discussion avec les patients sont présentés et les délégués pourront décrire le risque présenté par un patient de même que les bienfaits du traitement. Ils incluent des dépliants tirés des lignes directrices de même que des outils d‘estimation du risque et des exemples de discussion avec les patients. Dans tous les cas, les données probantes étayent les recommandations et décrivent l‘approche spécifique pour certains sous-groupes, comme les patients diabétiques, les personnes âgées et les patients atteints d‘insuffisance rénale. Nous espérons pouvoir montrer comment des lignes directrices de pratique cliniques formulées par des médecins de famille peuvent améliorer et simplifier les soins tout en faisant activement participer les patients dans la prise de décision vraiment partagée et éclairée.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S102019 11:15–12:15

Approach to Anxiety Disorders in Primary Care Jon Davine, MD, CCFP, FRCPC, Hamilton, ON 801AB MTCC

Learning Objectives: 1. use screening questions to make rapid diagnoses of specific anxiety disorders 2. apply psychotherapeutic techniques to deal with anxiety disorders 3. describe psychopharmacologic treatments for the different anxiety disorders Description: In this workshop, we will present an overview of some of the DSM-V diagnoses for anxiety disorders, including panic disorder, agoraphobia, obsessive-compulsive disorder and related disorders, generalized anxiety disorder, and social phobia. We will discuss how to use specific screening questions to make the diagnosis. We will also discuss pharmacologic and psychotherapeutic strategies for each of these disorders.

The pharmacologic data for this session will be based on the most recent 2014 guidelines for anxiety disorders.

S102129 11:15–12:15

Film in Medical Teaching: Refugee health care as a case study Russell Dawe, MD, CCFP, St. John‘s, NL 709 MTCC

Learning Objectives: 1. identify a concrete step-by-step process to create an original documentary film 2. recognize the strengths and weaknesses of film in medical teaching 3. recognize the application of these principles at an intellectual and emotional level, as experienced in the context of the film shown Description: This session will explore the role of film in medical teaching. “Refugee Health Care In Newfoundland”, the author‘s 16-minute film, will be presented and will serve as a basis for discussion to equip physicians, residents, and students to make appropriate use of film in their own settings and teaching programs. Narrative conveys not only one‘s conclusions on a topic, but also the process by which they are reached.

Film as a medium lends itself naturally to teaching medical-social themes in a patient–centred manner. Physicians and residents involved in teaching, and those with an interest in qualitative research, will particularly benefit from this session. Physicians with an interest in refugee health care would also benefit from this session, though such interest in not necessary.

S102862 11:15–12:15

Using Data to Improve Care and Outcomes in Primary Health Care Andrew Pinto, MD, CCFP, MSc, FRCPC, Toronto, ON 710 MTCC

Learning Objectives: 1. identify common sources of data about a family medicine practice that can be accessed to characterize individuals and the patient population 2. discuss the concept of ”shifting the curve” to reduce disease and of targeting interventions to reduce health inequities 3. understand basic ways of manipulating data in Excel to describe the distribution of disease in a family medicine practice Description: Family physicians have long cherished the principle that they are a resource to a defined practice population. The increased use of electronic medical records now provides rich data over many years on practice populations. However, many physicians find analyzing such data challenging. This workshop will begin with identifying common sources of data that are available to understand the health and determinants of health of individuals and a practice population. We will use such data to develop a practice health report, applying a population health approach to this assessment. We will then discuss the complementary concepts of ”shifting the curve” and ”hot spotting,” and examine how they apply to primary care settings. We will work through a number of examples from the St Michael‘s Hospital Academic Family Health Team, using data to understand the health of diabetics, patients with HIV infection, and patients with multimorbidity. The workshop participants will then work through an exercise in small groups using data on cancer screening. We will conclude by examining data manipulation in Microsoft Excel, a widely available and familiar piece of software. It is important that all family physicians have some familiarity with conducting an assessment of the health of their practice population; this workshop aims to support such efforts.

S102865 11:15–12:15

The Modern Canadian House Call: Understanding the evolving role of house calls, from policy to practice

Samir Sinha, MD, DPhil, FRCPC, Toronto, ON; Mark Nowaczynski, MD, CCFP, Toronto, ON 716A MTCC

Learning Objectives: 1. recognize the changing policy landscape that is encouraging a resurgence of house calls across Canada 2. discover the growing array of home-based primary and specialty care delivery models across Canada and the role technologies can play as an enabler 3. discover practical approaches to making both solo and collaborative house calls Description: Across Canada, primary care providers and geriatricians have long appreciated the inherent value of house calls in the provision of care for homebound patients. The way our modern health care system has been structured and financed has only led to an overall decline in the number of Canadian physicians providing house calls. The last few years have seen a growing number of jurisdictions recognizing the value of house calls and thus adapting health system policies and physician reimbursement models to encourage more house calls. Although fmf.cfpc.ca

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provinces such as Ontario are now seeing a major resurgence in house calls, despite certain policy and funding barriers, another significant barrier remains: too few physicians have training or comfort in delivering house calls. This session brings together a primary care physician, who exclusively does home visits with the frail elderly, and a geriatrician, who works collaboratively with his team to deliver specialist consults. Together they will give an overview of the evolution of home care medicine in Canada, as well as provide participants with a practical approach to doing a variety of house calls on their own and with other health and social care providers/specialists. The first part of the session will present the underlying reasons why various jurisdictions are making house calls a priority and the variety of policy and funding mechanisms being employed to encourage their growth. This part of the session aims to help participants appreciate the specific considerations required to enable the advancement of house calls medicine, as well as the policy pitfalls that should be avoided whenever possible. A description of a variety of home-based primary care models that are evolving across the country will be introduced. The second part of the session will give all participants the practicalities of what a house call should involve, from the perspective of experienced providers. Concepts such as what to take with you, and what exactly one can do in the home setting, including the intricacies of the ”fridge biopsy,” will be explored. Finally, tips on how to do collaborative home visits with a variety of professionals will be provided.

S102907 SIM Start-up: Perspectives on creating a high-fidelity simulation curriculum at a community 11:15–12:15 family medicine site Kim Cai, MD, CCFP, Toronto, ON; Harinee Surendra, MD, Markham, ON; Jean Mok, MD, CCFP, Markham, ON; Seyon Sathiaseelan, BSc, MD, CCFP (EM), Markham, ON 703 MTCC Learning Objectives: 1. discover how to solicit faculty buy-in, identify resources necessary for curriculum development, and avoid common pitfalls associated with simulation development and implementation 2. use evaluation tools to improve the quality of simulations and to evaluate knowledge acquisition in learners 3. discover and practise effective debriefing techniques learned as ”evaluator” and ”learner” in a hands-on simulated emergency scenario Description: This session will be of interest to family community doctors interested in developing simulations for continuing medical education or as teaching tools for learners. Perspectives from both evaluators and learners will be explored through a panel discussion. In addition, a hands-on simulation scenario will allow participants to practise evaluation and debriefing skills. The goal of the session is to empower community family doctors to create their own simulation curriculum within their distributed education sites.

S101391 11:15–12:15

A Road Map for Family Physicians Treating Adolescent Depression Sanjeev Bhatla, MDCM, CCFP, FCFP, Calgary, AB 501 MTCC

Learning Objectives: 1. diagnose depression in adolescence 2. use systematic approach to counsel adolescents with depression 3. recognize when and how to initiate antidepressant medication

S115049 11:15–12:15

Making a Smooth Transition Into Practice Jaspreet Manganat, MD, Mississauga, ON; Emy Martineau, MD 705 MTCC

Learning Objectives: 1. discuss key issues involving transitioning from residency into practice, including licensing, financial concerns, location and relocation, and contracts Description: The path from residency to practice can take many directions, be direct or winding, and involve different practice settings and communities. A panel of family medicine graduates will individually relate their varied experiences, sharing pearls they acquired along the way, and invite participants‘ questions. Residents will come away with resources and tips to use in their own transitions.

saturday • samedi

Description: The greatest predictor of effective counseling lies in the quality of trust and respect between patient and therapist. This places family physicians in an ideal position for counseling and treating adolescents with mental health conditions. This presentation provides a road-mapped approach to counseling adolescents in the primary care setting. The goals of this presentation are for participants to develop the confidence to diagnose depression in adolescence, to engage in therapy, and to know when and how to initiate antidepressant medication.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S102868 Frequent Emergency Department Patients: Improving care coordination in the ED 11:45–12:15 Patients souvent vus à l’urgence : Amélioration de la coordination des soins à l’urgence Jocelyn Charles, MD, CCFP, MScCH, Toronto, ON; Gayle Seddon, BScN, Toronto, ON; Anne Moorhouse, RN, PhD, Toronto, ON 718AB MTCC Learning Objectives: 1. recognize patients with complex care needs at higher risk of adverse events during transitions in care 2. define the role of the family physician in care transitions for complex patients 3. integrate the family physician‘s accumulated knowledge of the patient into collaborative care planning with other providers in the circle of care Description: Currently the top 5 per cent of complex patients consume 84 per cent of Ontario‘s hospital and home care costs. There is a critical need for a dynamic, person-centred care planning process for medically complex patients with real-time dialogue between primary care, emergency department (ED)/acute care, and community care providers at care transitions. A care pathway was developed in the emergency department using quality improvement methodology and care team collaboration. Medically complex patients with frequent ED use are now automatically flagged upon registration in the ED and an ED Care Coordination team is notified by secure email: geriatric emergency management (GEM) nurse, ED Community Care Access Centre (CCAC) care coordinator, social worker, occupational therapist/physical therapist. The GEM nurse initiates a comprehensive patient assessment in the ED right after triage and the ED CCAC Care Coordinator initiates a teleconference with the patient‘s family physician and the community care coordinator, with the patient‘s consent. Usual physician assessment is preceded and followed by an interprofessional huddle (including the GEM nurse, ED CCAC care coordinator, and social worker, occupational therapist, physical therapist) to ensure the patient‘s needs, goals, and team recommendations are clear. These patients then have the opportunity to initiate a coordinated care plan and follow up with their family physician and community CCAC care coordinator to complete their care plan. Strategies to engage family physicians in coordinating care for complex patients will be described. Safety is enhanced through better communication between patients, their family physicians, ED providers and community care providers; a clearer understanding of the patient‘s priorities, goals, barriers, and social determinants of health; and proactive and anticipatory care planning to optimize self-management in the community. Outcome measures to be presented include initiation and completion of a coordinated care plan, patient satisfaction survey, provider satisfaction survey, completion of medication reconciliation, identification of reasons and avoidable factors for ED visit, follow-up with family physician, subsequent ED visits, readmissions, and length of stay.

Objectifs d‘apprentissage : 1. reconnaître les patients qui requièrent des soins complexes et qui présentent un risque élevé d’événements indésirables durant la transition des soins 2. définir le rôle du médecin de famille durant les soins de transition pour les cas complexes 3. intégrer l’accumulation du savoir des médecins de famille à l’égard des patients dans la planification des soins coopératifs avec d’autres fournisseurs du cercle des soins Description : À l’heure actuelle, 84 % des coûts des soins hospitaliers et des soins à domicile en Ontario sont attribuables à la tranche supérieurede 5 % des cas complexes. Le besoin d’un processus dynamique de planification axé sur la personne pour les cas médicaux complexes est criant, de même qu’un dialogue en temps réel entre les fournisseurs de soins primaires, de soins d’urgence/soins aigus et de soins communautaires durant les soins de transition. Un cheminement des soins a été mis au point à l’urgence à l’aide d’une méthode d’amélioration de la qualité et de collaboration entre les membres de l’équipe de soins.

Les cas médicaux complexes qui reviennent souvent à l’urgence sont maintenant automatiquement signalés dès l’inscription à l’urgence et l’équipe de coordination des soins d’urgence est avisée par courriel sécurisé : infirmière en gestion des urgences gériatriques (GUG),coordonnateur des soins d’urgence du Centre d’accès aux soins communautaires (CASC), travailleur social, ergothérapeute/ physiothérapeute. Avec l’accord du patient, l’infirmière en GUG amorce immédiatement après le triage une évaluation complète du patient se trouvant à l’urgence et le coordonnateur des soins du CASC communique avec le médecin de famille du patient par téléconférence avec le coordonnateur des soins communautaires. L’évaluation du médecin habituel est précédée et suivie d’un regroupement interprofessionnel (composé de l’infirmière en GUG, du coordonnateur des soins du CASC et du travailleur social, de l’ergothérapeute et du physiothérapeute) pour veiller à ce que les besoins du patient et les recommandations de l’équipe soient clairs. Ces patients ont alors la chance de mettre de l’avant un plan de soins coordonnés et de faire un suivi auprès de leur médecin de famille et du coordonnateur de soins du CASC pour compléter leur plan de soins. Les stratégies visant à mobiliser les médecins de famille à coordonner les soins pour les patients complexes seront décrites.

La sécurité est améliorée par l’intermédiaire d’une meilleure communication entre les patients, leur médecin de famille, les fournisseurs desoins d’urgence et les fournisseurs de soins communautaires; une meilleure compréhension des priorités, des objectifs, des obstacles et des déterminants sociaux de santé du patient, de même que la planification des soins anticipés vise à optimiser l’auto-prise en charge dans la communauté. Les paramètres d’évaluation qui seront présentés sont l’initiation et l’achèvement d’un plan de soins coordonnés, un sondage de satisfaction du patient, un sondage de satisfaction du fournisseur, un bilan comparatif de la prise de tous les médicaments, la détermination des motifs et des facteurs évitables de la visite à l’urgence, le suivi avec le médecin de famille, les visites subséquentes à l’urgence, les réadmissions et la durée du séjour.

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S100482 13:45–14:15

What‘s New in Dermatology Therapy?

Hanna Nicolas, MD, CCFP, DipPDerm, Laval, QC HALL G MTCC

Learning Objectives: 1. identify new treatment options for a variety of dermatologic conditions 2. evaluate the efficacy of these new treatments based on the available evidence 3. incorporate some of these new treatments into daily practice or be able to advise patients about their use by dermatologists Description: There are a number of new topical and systemic medications in the field of dermatology that have come to market in the past few years. With this changing landscape of treatment options it is difficult to know how these new treatments compare to current therapies and what the potential is to integrate these into our practices. This session will look at some new treatments for onychomycosis, genital warts, rosacea, dermatitis, and psoriasis. These conditions are commonly seen in the office. Evaluating the potential benefits and drawbacks of new therapies for our patients will be discussed.

S102854 CFPC Health Advocacy Regarding Segregation and Mental Health Inside Canadian Prisons 13:45–14:45 Nader Sharifi, BSc, MD, CCFP, ABAM, CCHP, Coquitlam, BC; Ruth Elwood Martin, MD, MPH, CCFP, FCFP, Vancouver, BC; Marie Hayes, MD, CCFP, Sherbrooke, QC; Josiane Cyr, MD, CCFP, Montreal, QC; Susan Crouse, MD, CCFP, St. Phillippe, NB 715B MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. summarize established international evidence regarding health impacts of segregation inside prisons 2. review current segregation practices within Canadian correctional facilities 3. discuss ways that CFPC health care providers might advocate for restricting segregation practices within Canadian correctional facilities Description: Thousands of incarcerated people worldwide are housed in segregation or solitary confinement. In addition, persons are sometimes punished with solitary confinement for behaviour resulting from their mental illness. Solitary confinement with isolation and sensory deprivation causes harm. Long-term segregation can cause mental health symptoms. In people with mental illness, solitary confinement will exacerbate the symptoms. Participants will review the policy statement regarding segregation and mental health, which is being written by the CFPC Prison Health and Mental Health Program Committees, and will discuss ways to advocate for restricting or abolishing solitary confinement practices within Canadian correctional facilities.

saturday • samedi

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S101934 13:45–14:15

Cannabinoids and Chronic Pain Mark Ware, MBBS, MRCP(UK), MSc, Montreal, QC 701B MTCC

Learning Objectives: 1. communicate in a patient-centred way with patients who are requesting a prescription for medical cannabis 2. recognize both cannabis use disorder and when medical cannabis might be a reasonable option for someone 3. use existing tools that assist with medical cannabis decision making (eg, the CFPC preliminary guidance document, and a checklist developed by the presenter) Description: Family physicians are increasingly being asked about medical cannabis by patients, for reasons ranging from curiosity to abject desperation. Many have already tried cannabis, and many physicians do not feel equipped to have a meaningful discussion with their patients on this topic. This session will touch on the language needed to communicate with patients regarding cannabis use, the framework needed to separate medical from problematic recreational use, and the tools available to make an informed shared decision.

S100480 14:15–14:45

Addiction in Chronic Pain: Part of CPFM chronic pain group Joel Bordman, MD, Toronto, ON 701B MTCC

Learning Objectives: 1. formulate the differential diagnosis of aberrant opioid behaviours in patients with chronic pain 2. communicate effectively with patients when a diagnosis of addiction is being considered 3. provide ongoing support to patients who require a referral for addiction treatment Description: Dr Bordman will review the differential diagnosis of addictive behaviour in a chronic pain patient. He will explore treatment options for the patient with addictive behaviour and chronic pain. It is hoped that at the end of the session, the audience will have an increased comfort in dealing with possible addiction in the chronic pain patient.

S103000 13:45–14:15

A Matter of Mind: Approach to delirium in the home setting Andrea Moser, MD, MSc, CCFP, FCFP, CMD, Toronto, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe several ways to mitigate the risk of delirium and be able to educate seniors and caregivers 2. apply knowledge of common etiologies, non-pharmacological management strategies, and pharmacological strategies in a case study Description: A straightforward delirium is rarely the case in seniors where there are multifactorial etiologies. In the home setting, assessment is complex.

In this session, we will review the CMAJ Choosing Wisely Canada‘s ”Five Things to Know About ... Delirium” summary and discuss what investigations are available and how management can be accomplished at home. This short workshop will offer a review of ways to prevent delirium, examine key elements of the diagnosis of delirium, and focus on the unique challenge of an approach that is grounded in a patient‘s goals of care and current context. Using a case study, participants will apply the best practice that is unique to each individual patient (and family) within the local context and the resources available.

S95089 13:45–14:45

Managing Insomnia in Primary Care Office Purti Papneja, MD, CCFP, Toronto, ON 803A MTCC

Learning Objectives: 1. develop an approach to insomnia 2. discuss diagnosis and management tips for initial insomnia, maintenance insomnia, and parasomnias 3. review strategies on weaning off sleeping aids Description: It‘s estimated that approximately 30–40% of adults suffer from occasional insomnia and 15–20% of adults have chronic insomnia. Poor sleep can cause significant behavioural and physiological changes in an individual. It also contributes to workplace errors and motor vehicle accidents. In this interactive workshop, participants will work through chief cases of sleep-related complaints that are commonly encountered in family practice/walk-in clinics. By the end of the session, participants will have a clear approach to insomnia and understand the role of sleep studies—when to order and how to interpret the results. We will review the advances in treatment of obstructive sleep apnea, including CPAP, dental devices, and Provent, and how to improve patients‘ adherence to these modalities. Participants will also learn how to help patients get off their benzodiazepines or other sleep aids safely.

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S95449 13:45–14:45

Commonly Missed Orthopedic X-rays in the ED Radiographies orthopédiques souvent omises à l'urgence

Vu Kiet Tran, MD, MHSc, MBA, CEUS, Richmond Hill, ON 718AB MTCC

Learning Objectives: 1. enumerate which are the most commonly missed orthopedic X-rays 2. enumerate the specific radiographic signs of these commonly missed orthopedic injuries 3. elaborate tricks to mitigate these caveats Description: Missing an orthopedic injury or x-ray in the ED can bring significant morbidity and disability for the patient. Numerous factors in the emergency department can lead providers to be more at risk of missing these radiographic findings. One of them is the knowledge of these radiographic signs. Another is the constant distraction ER providers face on a minute-to-minute basis. What other factors come into play? Learn how you can mitigate against these risk factors and minimize the chances you will miss these injuries. Come and test your knowledge and find out what mistakes others have made so you don‘t make them!

Objectifs d‘apprentissage : 1. nommer les radiographies orthopédiques les plus souvent omises 2. nommer les signes radiographiques spécifiques de ces blessures orthopédiques souvent omises 3. concevoir des astuces pour régler ce problème Description : L‘omission d‘une blessure orthopédique sur une radiographie à l‘urgence peut entraîner morbidité et incapacité significatives pour le patient. À l‘urgence, de nombreux facteurs peuvent accroître le risque que les urgentologues omettent ces constatations radiographiques. Un de ces facteurs est la connaissance des signes radiographiques. Un autre est les distractions constantes auxquelles les urgentologues doivent faire face à l‘urgence d‘une minute à l‘autre. Quels sont les autres facteurs en jeu? Apprenez comment éliminer ces facteurs de risque et réduire au minimum les chances d‘omettre ces blessures. Venez tester vos connaissances et découvrez quelles erreurs ont déjà été commises afin de les éviter !

S96045 13:45–14:45

Smoking Cessation: Tools to make a difference in your practice Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON; Elaheh Mousa Ahmadi, MD, Edmonton, AB 714AB MTCC

Learning Objectives: 1. review the epidemiology of smoking in your practice 2. classify patients‘ readiness to make changes in their smoking 3. prescribe effective therapies and support to help promote this change using existing tools Description: Smoking is the leading cause of death in our patients, a scary thought. Patients know they should quit, but this is an addiction. We will review how to approach this common and frustrating condition in the office, and learn tools to allow real health change in your smokers, without getting you frustrated. Tools in your community will be reviewed.

S100268 13:45–14:45

Approach to Depression in Primary Care Jon Davine, MD, CCFP, FRCP(C), Hamilton, ON 801AB MTCC

Description: In this workshop, we present the psychiatric differential of the ”sad state,” and will comment on different treatments for the different diagnoses. We will then focus on the diagnosis and treatment of a major depressive episode. The use of psychotherapy will be commented on. We will focus on the current literature of the psychopharmacologic treatment of depression. This will include optimal choices of antidepressants, based on the literature. We will then go on to discuss how to optimize the antidepressant dosing, commenting on starting dosages, and methods of increasing dosages. We then go on to discuss the use of augmenting techniques, as well as switching from an antidepressant to another. Dealing with the side effects of antidepressants will be addressed. Other issues such as the use of antidepressants in the pediatric population, the use of electroconvulsive therapy (ECT), and the use of transcranial magnetic stimulation (TMS) will be discussed. This will be an interactive seminar encouraging audience participation.

saturday • samedi

Learning Objectives: 1. describe the psychiatric differential of the ”sad state” 2. describe the current treatment approaches to depression, both psychopharmacologic and psychotherapeutic 3. rule out organic factors in the assessment of the depressed patient

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S101262 13:45–14:45

Buprenorphine/Naloxone: Office-based management of opioid dependence Curtis Handford, MD, CCFP, MHSc, Toronto, ON; Dale Wiebe, MD, CCFP, Toronto, ON 717B MTCC

Learning Objectives: 1. elicit the clinical clues that suggest a diagnosis of opioid dependence that may be amenable to opioid maintenance treatment 2. describe the pharmaco-dynamics and kinetics of buprenorphine/naloxone and the resulting implications in terms of dosing, monitoring, and side effects.

3. outline the steps involved in achieving a safe and effective patient induction onto buprenorphine/naloxone in an office-based setting.

Description: This workshop focuses on developing the skills of family physicians in diagnosing opioid dependence in their practices, identifying when it is appropriate to offer and initiate buprenorphine/naloxone treatment in their offices, and understanding basic principles of initiating and monitoring buprenorphine/naloxone treatment in the office. The workshop will be case based and interactive. Both the 2010 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain and CAMH‘s 2011 Bupenorphine/Naloxone Clinical Practice Guidelines will be heavily utilized and referenced. Part of the workshop will be devoted to assisting providers in recognizing which patients receiving prescriptions for chronic opioid therapy have likely become addicted to opioids and would most likely benefit from opioid maintenance therapy, such as with buprenorphine/naloxone. The ultimate goal is for family physicians to leave the workshop with a foundational understanding of the core concepts of safe and effective use of buprenorphine/naloxone in their practices.

S101401 Intrapartum Skills: A refresher of specific skills 13:45–14:45 Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Anne Biringer, MD, CCFP, Toronto, ON; Shanna Fenton, MD, CCFP, FCFP, Saskatoon, SK; Kate Miller, MD, CCFP; Balbina Russillo, MD, CCFP, Mont-Royal, QC; Sudha Koppula, MD, CCFP, Edmonton, AB 717A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. perform hands-on intrapartum skills such as vacuum-assisted birth, release of shoulder dystocia, somersault maneuver for tight cords, and Foley catheter insertion for induction 2. manage postpartum hemorrhage Description: This interactive session will provide participants with an opportunity to develop further skills in intrapartum care. In small groups, participants will have the opportunity to review and practise crucial intrapartum skills such as vacuum-assisted birth, release of shoulder dystocia, pudendal block, and somersault maneuver for tight cords. Additional skills of placement of Foley catheter for induction and management of postpartum hemorrhage will be offered as part of this session.

S101660 13:45–14:45

What's New, True, and False, in 2015: Brief evidence updates for clinically relevant primary care topics Michael Kolber, BSc, MD, CCFP, MSc, FCFP, Edmonton, AB; G.M. Allan, MD, CCFP, FCFP, Edmonton, AB 716A MTCC

Learning Objectives: 1. review numerous evidence updates relevant to primary care from the last year 2. recognize that clinical knowledge and practice continue to be challenged and updated to the benefit of patients Description: In clinical update for 2015: brief reviews of clinically relevant topics in primary care will be presented. Typically each topic / knowledge piece will be reviewed in two minutes, which allows for a breadth of clinical topics / knowledge pieces to be presented and discussed.

These reviews, based on relevant evidence from the last year, include: new knowledge, eg, new therapy, diagnostic test, or use for existing medication)—”new”; confirmation of current practice—”true”; refuting current practice / understanding—”poo”. Examples of potential topics for 2015 include anti-viral therapy for influenza, fecal transplant for clostridium difficil, and electronic nicotine replacement systems.

S101771 13:45–14:45

Reducing the Hidden Cost of Immunization: Management of immunization pain and fear across the lifespan . Meghan McMurtry, PhD, C Psych, Guelph, ON; Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON; C Anna Taddio, BScPhm, MSc, PhD, Toronto, ON 701A MTCC

Learning Objectives: 1. describe the importance of managing immunization-related pain and fear 2. identify the ”Four Ps” (procedural, physical, pharmacological, psychological) of immunization-related pain and fear management 3. implement evidence-based pain and fear management strategies into clinical practice Description: Vaccines represent one of medicine‘s greatest achievements and are responsible for the reduction of a host of infectious diseases. Canadian children undergo well over two dozen vaccinations before the age of 18 years while adults may also receive yearly influenza vaccinations.

Pain has been deemed an adverse effect of vaccines delivered by needles. There are evidence-based approaches to managing needle-related pain and distress but they are not being implemented in routine care. This is a problem because inadequate management of pain and fear related to immunizations has serious consequences that affect not only the recipient but also health care professionals, family members, and fmf.cfpc.ca

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society at large. Short-term consequences include increased distress during the procedure and associated risk of injury (eg, fainting, flailing), longer procedure times, and a negative experience for the recipient, health care professional, and caregivers alike. Longerterm consequences include negative memories, increased fear of future procedures including development of needle phobia, and non-compliance with vaccination schedules, which may ultimately affect herd immunity. The Help Eliminate Pain in Kids Team created the first clinical practice guideline for immunization pain management in 2010; we have recently updated this guideline to provide guidance on the management of immunization-related pain and fear across the lifespan. This session will transform the cutting-edge results from a series of rigorous systematic reviews into accessible, clinically feasible pain and fear management techniques. Strategies will be grouped according to the ”Four Ps” approach: 1) procedural (eg, no aspiration, most painful vaccine last), physical (eg, upright positioning, breastfeeding), pharmacological (eg, sweet-tasting solutions, topical anesthetics), and psychological (eg, music, video distraction). Brief videos and case studies will be used to familiarize the practitioners with how to apply these simple, best-practice techniques for their patients of various ages. Practitioner-focused resources will be provided.

S102111 13:45–14:45

The Canadian Cardiovascular Society Heart Failure Companion: Bridging guidelines to your practice Jonathan Howlett, MD, CCFP, FRCPC, Calgary, AB, Adam Grzeslo, MD, CCFP, FCFP, Burlington, ON 716B MTCC

Learning Objectives: 1. apply the Canadian guidelines for identifying, targeting, and managing dyslipidemia 2. understand the role of non-statin drugs in cardiovascular risk 3. discuss new evidence and provide updated evidence-based care for patients living with and at risk of developing cardiovascular disease Description: Many serious cardiovascular events occur in individuals with no prior manifestation of cardiovascular disease (CVD), and these events can often result in death. Awareness of the contributions of various risk factors to the occurrence of CVD is growing.

Asymptomatic individuals with multiple risk factors at low or moderate levels can be at greater risk for CVD than those with a single risk factor at a high level. Dyslipidemia is a risk factor that commonly coexists with other factors such as diabetes and hypertension and is modifiable through lifestyle changes and/or medications. There remains a lot of interest and questions in dyslipidemia management, given the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Dyslipidemia guidelines, as well as the new guidelines slated for release from the European Society of Cardiology in 2015. The Canadian guidelines will be updated in 2015. In this case-based presentation, members of the Canadian Cardiovascular Society Dyslipidemia Guidelines Panel will explain the latest evidence and recommendations needed to provide quality evidence-based care for patients living with and at risk of developing dyslipidemia.

S101711 13:45–14:45

Sleeping for Two: Teaching moms and infants to sleep through the night Sanjeev Bhatla, MDCM, CCFP, FCFP, Calgary, AB; Lianne Tomfohr, PhD, R Psych,Calgary, AB 501 MTCC

Learning Objectives: 1. identify and apply effective treatment strategies for maternal insomnia (maternal sleep training) 2. describe easy and evidence-based approach for infant sleep training 3. review pharmacotherapy for refractory insomnia in pregnancy

S101455 13:45–15:30

Keeping Compassion in Family Practice: Lessons learned Françoise Mathieu, MEd, CCC, Kingston, ON; Rupa Patel, MD, CCFP, Kingston, ON 711 MTCC

Learning Objectives: 1. identify the difference between burnout, compassion fatigue, secondary trauma, and moral distress 2. recall the most recent findings on effective management of burnout and compassion fatigue for physicians 3. acquire a compassion fatigue tool kit with five essential skills for best practice Description: This presentation was first offered at FMF 2014 and received extremely positive feedback. Participants asked us to consider returning to present at FMF 2015. Burnout and compassion fatigue may now be familiar terms to you, but how is that reflected in your daily practice? Family physicians are facing multiple pressures: a need to stay on top of new treatments; seeing increasing numbers of

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Description: Restorative sleep plays a critical role in maintaining health and well-being. Many pregnant and postpartum women suffer from chronic sleep deprivation, putting them at increased risk for depression, anxiety, and other health problems. This presentation describes an effective and brief cognitive behaviour treatment for insomnia that family physicians can deliver in office visits. A simple technique for sleep training infants is promoted, with evidence-based support. Safe pharmacotherapy for refractory insomnia in pregnancy will be reviewed.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE patients, often with high needs and complex issues; and increasing administrative work. Recognizing and managing compassion fatigue will help keep you able to do the work you used to love to do. Please join one of Canada‘s leading experts in compassion fatigue and a fellow family physician while they explore the newest findings on what it takes to be a healthy family physician in 2015. Handouts will be available in both English and French, and questions will be taken in both official languages. We will present ”The compassion fatigue tool kit: 5 essentials for best practice.”

S101448 Making Teams Work 13:45–16:00 Stephen Darcy, MD, CCFP, FCFP, Mount Pearl, NL; Lisa Bishop, PharmD, St John‘s, NL; Susan Avery, MD, CCFP, St John‘s, NL 709 MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. identify the attributes of an effectively functioning team 2. appreciate the impact of team composition, leadership, and conflict on team effectiveness 3. develop the skills to promote team development and manage team conflict Description: Family doctors are more and more finding themselves as members of teams whether in the clinical setting or when involved in research. This workshop is geared for family physicians, residents, students, and other health care professionals who are part of a clinical or research team.

The session will be largely interactive in nature and involve group exercises and discussion. The workshop will focus on the formation and maintenance of effective teams and will help the participant identify and appreciate the factors that influence effective team building while providing insight into some elements of team dynamics. The participant will also develop strategies to deal with conflicts that may arise in the team setting. Further, as a result of participation in the workshop, it is hoped that attitudes toward team participation may be more positive and confident.

S102283 13:45–16:00

Teaching Resiliency to Resident Doctors for a Rewarding and Sustainable Career Christina Nowik, MD, Ottawa, ON; Nureen Sumar, MD, Calgary, AB; Simon Moore, MD, CCFP, Vancouver, BC 705 MTCC

Learning Objectives: 1. recognize the impact of distress on mental resiliency and the importance of early intervention 2. discover skills to manage shifts in mental resiliency 3. support the need for proactive and systematic implementation of resiliency training in medical education Description: Resiliency training is the development of skills to effectively identify, cope with, and recover from challenging experiences. Residency training is a particularly dynamic and stressful time for many trainees, who must balance educational and personal responsibilities with providing patient care, often making significantly life-altering decisions in emotionally charged situations. Over two-thirds of respondents to the 2013 CAIR National Resident Survey reported that work-related fatigue had an impact on their physical health (83.3%), on their relationships with family (79.8%) and friends (75.7%), and on their mental health (69.9%). Skills-based training to help mitigate stress can assist residents in overcoming adversity and provide them with the tools to better support their peers and patients, not only during their medical training but also over the course of their careers. Resident Doctors of Canada advocates strongly for the implementation of a formal resiliency curriculum, tailored to the needs of resident doctors, as a mandatory component of medical education. Resident Doctors of Canada has developed a skills-based resiliency curriculum with content support from the Department of National Defence‘s Road to Mental Readiness Program. It highlights the importance of promoting resident doctor mental resiliency by fostering supportive and positive learning environments and advocates for a systematic approach to understanding and addressing the anticipated stresses of residency. This session will include an interactive overview of the curriculum, including the demonstration and application of tools, such as the Mental Health Continuum, that will help resident doctors, clinical educators, allied health professionals, and support staff recognize early signs of varying levels of distress on mental resiliency, as well as apply effective evidence-based skills (known as the Big 4+) to help manage these stressors.

S123056 Role of the Resident Represtative on Accreditation Visits 13:45–16:00 Keith Wycliffe-Jones, MD, CCFP, Calgary, AB; Shirley Schipper, MD, CCFP, Edmonton, AB; Steve Hawrylyshyn, MD, Toronto, ON ROSEDALE Room – DELTA TORONTO HOTEL Learning Objectives: 1. share and discuss the proposed major changes in both accreditation standards and accreditation processes for family medicine residency training Description: The College of Family Physicians of Canada (CFPC) accredits residency training programs in family medicine; family medicine/emergency medicine; and enhanced skills at all 17 medical schools in Canada. The purpose of accreditation is twofold: to attest to the educational quality of accredited programs and to ensure sufficient uniformity and portability to allow residents from across Canada to qualify for the CFPC examinations as residency-eligible candidates. The Accreditation Committee is responsible for setting standards for residency training.

The role of the resident surveyor as a member of the Accreditation Survey Team is important: Learn why. Enrich your academic experience and increase your understanding of accreditation in medical education and as a quality assurance process. Volunteer opportunities exist to get involved and make a difference in family medicine programs across the country. This session is open to all family medicine residents.

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S102575 13:45–16:00

Crossing Professional Boundaries: Pearls and pitfalls Fiona Bergin, MD, CCFP, MEd, Halifax, NS; Stewart Cameron, MD, CCFP, FCFP, MAEd, Halifax, NS 707 MTCC

Learning Objectives: 1. identify and understand the significance of boundary transgressions in the medical educational setting 2. identify strategies for minimizing boundary transgressions 3. reflect on a personal approach to maintaining and promoting healthy boundaries with learners and colleagues in medical education settings Description: Professional boundaries delineate the area separating therapeutic attitudes and behaviours from potentially exploitative ones. In medicine, professional boundaries are most commonly discussed in the context of providing patient care and the concern is for the patient who might be harmed by the boundary transgression. Learners, like patients, are also in a relationship of unequal power with respect to their clinical or faculty supervisors, and can similarly be harmed when professional boundaries are not maintained with them or others in their learning environment. Yet boundary crossings are not uncommon and many would argue they are wellintentioned and might even be beneficial to the learner. The challenge is in identifying when the harms might outweigh the benefits and how to avoid the pitfalls inherent in boundary crossings. In this session, we will briefly review the literature on professional boundaries in the educational setting. In small groups, we will discuss several cases that illustrate boundary crossings and critique why and how they occurred. Finally, we will reflect on and share strategies to promote and maintain healthy professional boundaries in our educational settings.

S101935 New Strategies in the Management of Actinic Keratosis 14:15–14:45 Darshini Persaude, MBBS, CCFP, FCFP, Diploma in Practical Dermatology, Pickering, ON; Trina Stewart, MD, CCFP, FCFP, Summerside, PE 401 MTCC Learning Objectives: 1. identify patients with actinic keratosis and non-melanoma skin cancers and describe the progression from actinic keratosis to squamous cell cancer 2. recognize risk factors for the development of actinic keratosis and non-melanoma skin cancer and link them to prevention strategies 3. describe the current treatment approaches for actinic keratosis and review current guidelines for management Description: Actinic keratoses (AKs) are common skin lesions that can progress to squamous cell carcinoma. In fact, people with actinic keratoses have an increased risk for all types of skin cancer, including basal cell skin cancer, squamous cell skin cancer, and melanoma.

Treatment and prevention of AKs in a timely manner is important in reducing the incidence of non-melanoma skin cancer. A wide array of treatment options are available to the family physician today. These include physician- and patient-administered therapies as well as targeted and field treatment approaches. This case-based interactive program will allow primary care providers to recognize the risk factors for AK and identify patients with AKs. They will be able to identify strategies to improve outcomes through prevention, early treatment, and timely follow-up. We will review an approach to treatment based on current guidelines and consensus expert opinion.

S109634 14:15–16:00

Monica Branigan, MD, MHSc (Bioethics), Toronto, ON; Doris Barwich, MD, CCFP, Delta, BC 713A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. describe the current literature regarding desire-to-die statements (DTDS) and requests to hasten death 2. explore evidence-based interventions in responding compassionately to DTDS, including dignity therapy principles and therapeutic communication principles 3. identify and respond to barriers to open conversation Description: Requests to hasten death are common in those with life-threatening illness or irremediable conditions. These requests can vary over time and with disease trajectory, symptom load, or perceived burden to others. Importantly, these statements and requests vary significantly regarding their underlying intention. Some patients are expressing a readiness to die; some, a plea to assist with living; and a small minority, a request for physician assistance in hastening death. With the anticipated change in legislation to allow for physician-assisted death, the options in how we might respond to these statements will change profoundly. As baby boomers who value control and autonomy approach aging, chronic illness, and death, these conversations will become more compelling. A compassionate exploration between patient and physician is necessary to help the patient clarify his or her intention, and to help the physician assess the nature of the request; consider interventions to mitigate suffering; or address questions, concerns, or fears. This

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Exploring Requests to Hasten Death (2)

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE exploration itself has the potential to be experienced as therapeutic by the patient. However, many barriers exist—in ourselves and in our institutions—that make these open conversations difficult. Fortunately, resources exist to support these conversations, as well as evidencebased interventions with which we can respond. In this workshop we will begin with a short didactic session, then view and discuss some videos and reflect on cases in small groups. We will brainstorm as a group about emerging best practice in responding to these requests, as well as ways to overcome common barriers to open conversations. This workshop will not focus on questions regarding possible participation in physician-assisted death but rather on the true exploration of a desire-to-die statement. Presenters will include facilitators from the Canadian Society of Palliative Care Physicians.

S101600 15:00–15:30

Oncological Emergencies Anna Wilkinson, MSc, MD, CCFP, Ottawa, ON 401 MTCC

Learning Objectives: 1. identify the common oncological emergencies which may present to the family physician 2. recognize the presentation of common oncological emergencies 3. describe the appropriate management of oncological emergencies Description: As our population ages and the incidence of cancer continues to climb, cancer patients will constitute increasingly significant proportions of family practices. Family physicians must therefore be equipped to diagnose and manage common oncological emergencies that may present in patients with previously undiagnosed malignancies, patients on treatment, or palliative patients. This session will describe the diagnosis of common oncological emergencies that family physicians might see in the emergency room or their office. Oncological emergencies will be categorized as metabolic, structural, or side effects from chemotherapy; and corresponding topics such as hypercalcemia, superior vena cava syndrome, spinal cord compression, febrile neutropenia, and tumour lysis syndrome will be addressed. Management of these emergencies will be described, allowing family physicians to have greater confidence in caring for the oncology patients in their practices.

S102016 15:00–15:30

Fracture Prevention Recommendations for Long-Term Care Recommandations visant la prévention des fractures en soins prolongés

Alexandra Papaioannou, BScN, MD, MSc, FRCPC, FACP, Hamilton, ON; Sid Feldman, MD, CCFP, FCFP, Toronto, ON 718AB MTCC Learning Objectives: 1. understand and have working knowledge of the recommendations surrounding osteoporosis and falls strategies and how to apply them in clinical practice 2. apply recommendations and resource tools for fracture prevention in frail older adults Description: Physicians caring for frail older adults at high risk for falls and fractures in long-term care (LTC) face multiple challenges, including multiple comorbidities, polypharmacy, and end-of-life care, while practice guidelines typically do not address this population. There is a clear need to integrate osteoporosis and falls strategies to reduce fracture. The goal of fracture prevention is to reduce pain, immobility, and transfers to hospital and to maximize opportunity for quality living among frail older adults. The implications of these guidelines for frail older adults are highly relevant.

Objectifs d‘apprentissage : 1. comprendre et avoir une connaissance pratique des recommandations portant sur l‘ostéoporose et les stratégies contre les chutes et la façon de les appliquer en pratique clinique 2. appliquer les recommandations et les outils de prévention des fractures chez les patients âgés fragiles Description : Les médecins qui soignent des patients âgés fragiles en soins prolongés présentant un risque élevé de chutes et de fractures font face à de nombreux défis, notamment les comorbidités multiples, la polypharmacie et les soins de fin de vie, alors que les lignes directrices restent coites sur cette population. Le besoin d‘intégrer l‘ostéoporose et les stratégies contre les chutes ne fait aucun doute pour réduire les fractures.

La prévention des fractures vise à réduire la douleur, l‘immobilité et les transferts dans les hôpitaux, et de maximiser les chances que les adultes âgés fragiles aient une bonne qualité de vie. Les répercussions de ces lignes directrices pour les adultes âgés fragiles sont très pertinentes.

S102485 15:00–15:30

Problem Gambling: Comorbidities and the impact on families Daniela Lobo, MD, PhD, Toronto, ON; Toula Kourgiantakis, MSW, RSW, RMFT, Toronto, ON 701B MTCC

Learning Objectives: 1. screen quickly and efficiently for gambling problems and provide treatment referrals 2. understand the most common comorbidities present in problem gamblers 3. provide initial resources for families affected by problem gambling Description Problem gambling (PG) is a public health issue with adverse consequences for individuals and families. In Canada, 2.4 per cent of the population has a gambling problem and this rate is two to four times higher among youth. Problem gambling has high rates of comorbidity with other addictions and psychiatric disorders. A prevalence study (N = 49,093) found that 73 per cent of PG individuals had an alcohol fmf.cfpc.ca

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use disorder, 38 per cent had a drug use disorder, 60 per cent had nicotine dependence, 50 per cent had mood disorders, 41 per cent had an anxiety disorder, and 61 per cent had a personality disorder. Problem gambling is also associated with high rates of trauma, suicidality, financial problems, and legal issues. Families are also greatly affected, with increased risks of child maltreatment, family violence, separation/divorce, and intergenerational transmission of PG. Despite the elevated risks for PG individuals and their families, research shows that only 3 to 6 per cent of those with a gambling problem seek treatment and 50 per cent drop out of treatment. These individuals often see physicians in primary care settings and present physical and mental health problems, but do not disclose problem gambling as a contributing factor. This presentation will describe the symptoms of problem and disordered gambling and discuss the most common comorbidities, as well as the impact of PG on families. We will also provide family physicians with information on screening, treatment, and referral consistent with evidence-based practices.

S102831 15:00–15:30

Acne Vulgaris in 2015 Jessica Hunter-Orange, MD, CCFP, DipPDerm, London, ON 714AB MTCC

Learning Objectives: 1. review the common types of acne and pathophysiology seen in day-to-day practice 2. recognize the need for ongoing follow-up due to the chronic nature of this disease 3. discuss the importance of the use of retinoids at all stages and describe combination therapies that have become available recently Description: This session will briefly review the different types and pathogenesis of acne. The concept of acne as a chronic disease of young adulthood will be highlighted. We will review the use of retinoids at all stages of the disease, as well as the use of combination therapy and the need to limit antibiotic resistance. We will also look at the three most recently available topical treatments and how best to use these in your practice. In addition, we will discuss the oral treatments available for severe acne and when referral might be necessary.

S102846 15:30–16:00

Clinical Framework for the Management of Hair Loss in Primary Care Darshini Persaude, MD, CCFP, FCFP, Diploma in Practical Dermatology, Pickering, ON 714AB MTCC

Learning Objectives: 1. assess the patient who presents with hair loss and identify the type of hair loss 2. recognize patients that will need early intervention or referral to secondary care 3. select appropriate first- and second-line treatments, depending on the cause Description: Hair loss is a common problem in clinical practice and the effects are often devastating for patients. Early diagnosis and intervention can make a difference in the management and outcomes for these patients. This workshop aims to give primary care providers a clinical framework to use in the assessment and management of patients with hair loss.

S96121 15:00–16:00

Can You Please Get Them to Stop Coughing?

Alan Kaplan, MD, CCFP(EM), FCFP, Richmond Hill, ON; Robert Hauptman, MD, St Albert, AB 716A MTCC

Description: A patient who is coughing suffers from reduced quality of life, fears, fatigue, and embarrassment. There are many causes of cough, ranging from mild to life-threatening. This case-based workshop will take us from acute causes of cough to chronic cough. We will review how to approach your patient and their cough in regards to diagnosis and treatment. We will move from the common to the uncommon; you will be on the hot seat to make the diagnosis and recommend treatments.

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Learning Objectives: 1. differentiate between acute, subacute, and chronic cough 2. review the diagnostic approach and appropriate treatments 3. have fun with a number of challenging cases

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S101840 Integrating Preconception Health Promotion Into Primary Care 15:00–16:00 Patricia Mousmanis, MD, CCFP, FCFP, Richmond Hill, ON; Lisa Graves, MD, CCFP, FCFP, Ancaster, ON; Deanna Telner, MD, CCFP, FCFP, North York, ON 701A MTCC Learning Objectives: 1. describe evidence-based recommendations for preconception health interventions 2. integrate clinical strategies into primary care practice for women and men of reproductive age, including LGBTQ populations 3. practise health promotion strategies to improve preconception and interconception health interventions in higher-risk clinical situations (abuse survivors, mental illness, and addictions) Description: This interactive, case-based workshop will look at the evidence for preconception interventions and how to integrate them into primary care practice environments. A new preconception tool developed by the Centre for Effective Practice and the new Ontario Public Health Association preconception health position paper ”SHIFT: Enhancing the Health of Ontarians. A call to action for preconception health promotion and care” will be introduced as a framework to provide strategies that clinicians can use in everyday practice. Specific clinical pearls for interventions with youth, males, LGBTQ clients, and high-risk women (such as those who are abuse survivors or have addictions or mental illness) will be reviewed through the use of cases and small group discussion.

S102010 15:00–16:00

Mixing and Matching: Layering medications as family physicians Jon Davine, MD, CCFP, FRCPC, Hamilton, ON 801AB MTCC

Learning Objectives: 1. identify scenarios of combining psychiatric medications that are pertinent to the primary care situation 2. combine medications to optimize antidepressant treatment response 3. combine medications to optimize sleeping Description: Often, psychopharmacologic treatment of psychiatric conditions involves combining medications in an appropriate manner. In this workshop, we will discuss a number of scenarios where this occurs, including augmenting a partial response to antidepressants, dealing with treatmentresistant depressions, treating acute manic conditions, dealing with insomnia, dealing with anxiety disorders, and dealing with schizoaffective disorder, among others. Participants will be encouraged to bring up some of their own cases where issues of ”layering” occurred.

S102428 Making Patient Safety a Priority: Moving from a culture of blame to learning via narrative 15:00–16:00 Tejal Patel, MD, CCFP, Hamilton, ON; Joyce Zazulak, MD, CCFP, FCFP, Dundas, ON; Doug Oliver, MD, CCFP, FCFP, Dundas, ON 715A MTCC — Small group interactive workshop – limited seating.

Learning Objectives: 1. appreciate the components and benefits of a narrative-based patient safety program in a primary care setting 2. participate in an abbreviated patient safety “rounds” 3. implement similar programs within participant‘s own clinical settings to improve overall patient and clinician well-being Description: At McMaster Family Practice, we have adopted the practice of meeting regularly in a safe, non-blaming, and supportive environment to share our stories of near and actual misses, with the goal of improving patient safety. The purpose of this session is to demonstrate how, through the use of stories, we are able to explore the impact of medical error on both patients and caregivers, pass on knowledge and experience, and gain insights that can lead to effective change in practice or policies, in an environment that breaks down the medical “culture of blame” and traditional sense of hierarchy, to make patient safety a priority. All primary care clinicians, including allied health professionals and learners, would be welcome to attend. The workshop will be comprised of a short presentation to describe the key components of our program and the unique aspects of patient safety in a family practice setting, followed by an interactive mock ”patient safety rounds,” to allow participants the opportunity to share their stories and learn from one another in a setting where the process of storytelling and learning, rather than a need to lay blame or fix a problem, is the focus. We will close the session with some suggestions on how participants can begin to have open discussions and to foster an environment that is safer for both patients and caregivers in their own practices.

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S102563 15:00–16:00

Office Management of Early Pregnancy Miscarriage and Termination Ellen Wiebe, MD, CCFP, FCFP, Vancouver, BC 802AB MTCC

Learning Objectives: 1. choose appropriate medication protocols for women who have missed abortions (anembryonic/fetal demise) 2. describe the risks and side effects of medications used in early pregnancy termination: misoprostol, methotrexate, and mifepristone 3. safely select patients wanting pregnancy termination for use of misoprostol with either methotrexate or mifepristone Description: This one-hour session will focus on clarification of effective, safe medication use in early pregnancy for women who have a known miscarriage (anembryonic or demise), or who seek early pregnancy termination. We will discuss off-label use of misoprostol and methotrexate as well as the newly approved mifepristone. Clinical scenarios and review of recent research will allow the participant to feel confident in selecting appropriate medication protocols.

S100279 15:00–16:00

Caring for the Hepatitis B Carrier Patient: How can the primary care practitioner add value?

Vu Kiet Tran, MD, MHSC, MBA, Richmond Hill, ON 713b MTCC

Learning Objectives: 1. list causes of hepatitis B transmission 2. enumerate monitoring strategies 3. enumerate criteria for referral to a hepatologist Description: With the growing numbers of new immigrants (especially from South-East Asia and China) to Canada, there is also a growing number of patients with chronic hepatitis B (carrier state). Unfortunately, many are not aware they are carriers of the virus. For the primary care practitioner, what is the most effective way to screen them? Then, what tests are necessary for monitoring? When to refer to our specialist colleagues? Who should be immunized? Come and learn how primary care can make a difference in these patients.

Ultimately, we all want to prevent cirrhosis and liver malignancy for our patients.

S99190 Primary Health Care and Homeless Youth: A multidisciplinary approach 15:00–16:00 Naomi Thulien, NP-PHC, MN, PhD candidate, Oakville, ON; Karen Weyman, MD, MEd, CCFP, FCFP, Toronto ON; Eileen Murphy, RN, BScN, Toronto, ON 501 MTCC Learning Objectives: 1. identify common health-related concerns of homeless youth 2. confidently manage a ”typical” office visit with homeless youth 3. describe how to effectively utilize a team approach to caring for homeless youth

saturday • samedi

Description: Youth (aged 16–24 years) constitute the fastest-growing segment of the homeless population in Canada. One of the challenges in providing care to homeless youth is that even the most simple health matter is complicated by the fact that these youth are frequently struggling with issues related to mental illness and addiction, as well as attempting to heal from the emotional trauma experienced as a result of a chaotic childhood. In addition, the transient nature of youth homelessness means that the health care these youth typically receive is inconsistent and fragmented, punctuated by frequent visits to emergency rooms across Canada. A multidisciplinary team of health care providers from Covenant House Toronto—Canada‘s largest shelter for homeless youth—will share their expertise in providing primary health care to this population. Common health-related concerns and clinical pearls are highlighted, as well as the opportunity to observe and participate in a “typical” clinical encounter.

LEGEND / LÉGENDE Simultaneous interpretation / Interprétation simultanée

MTCC Metro Toronto Convention Centre / Palais des congrès du Toronto métropolitain fmf.cfpc.ca

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SCIENTIFIC PROGRAM | SATURDAY 14 SAMEDI | PROGRAMME SCIENTIFIQUE S101339 15:30–16:00

Help, Doctor! My Face Is Red Christine Rivet, MDCM, CCFP(EM), FCFP, MClSc, Ottawa, ON 803A MTCC

Learning Objectives: 1. discuss the practical step-by-step approach to starting and following patients on oral retinoids 2. describe differences between acne and conditions with a similar appearance such as rosacea, perioral dermatitis, atopic dermatitis, and seborrheic dermatitis 3. give advice about what patients can expect from their skin condition and what they can expect from its treatment Description: This is a very interactive workshop that starts by discussing the objectives of the session, then giving a ”warm-up quiz” of common patient ”red-face” scenarios with multiple-choice answers. There are then about 10 cases of patients with different presentations of a red face. I use photos and a brief patient scenario for participants to discuss the diagnosis and management of each case for a few minutes in a small group of about four participants. Then the larger group discusses diagnosis and treatment of the patients. One example is a 13-year-old boy with a rash on his face that appears similar to acne but is keratosis pilaris. The differences between keratosis pilaris of the face and acne are discussed. Another example is a 15-year-old girl with severe acne and her management options. A third scenario is a 52-year-old woman with severe facial eczema who has tried several treatments. At the end I go back to the initial warm-up quiz to review the answers with the group.

I have given this workshop to both residents and local colleagues and it has been very well received. As family physicians, up to 20 per cent of our practice includes skin problems and I have found that there is much enthusiasm to learn more about dermatology from a family physician‘s perspective.

S101460 15:30–16:00

The Occasional HIV+ Patient James Owen, MD, CCFP, Toronto, ON; Kelly Anderson, MD, CCFP, Toronto, ON 716B MTCC

Learning Objectives: 1. diagnose and perform an initial workup for HIV+ patients 2. independently monitor and manage stable HIV+ patients 3. appreciate that family physicians already have many of the competencies necessary for basic HIV care Description: HIV is an increasingly common diagnosis in both rural and urban family practice. In many regions, access to specialist HIV care is limited; however, as skilled managers of common chronic conditions such as diabetes and cardiovascular disease, family physicians have many of the necessary skills to competently manage stable HIV infection. This workshop, targeted at the generalist family physician, aims to increase your capacity to care for the occasional HIV+ patient. We will highlight the basic workup and management of HIV infection. We will also explore common preventive care recommendations for HIV+ patients, including cancer screening, immunizations, and the management of cardiovascular risk factors.

Silent Auction

Encan silencieux

The Research and Education Foundation

Fondation pour la recherche et l’éducation

Our always-popular Silent Auction is back! Be sure to visit College Square to check out our impressive and diverse lineup of goods. The Auction runs from Thursday, November 12th through Saturday, November 14th. All proceeds support family medicine research and education initiatives, so please bid with your heart!

Notre très populaire Encan silencieux est de retour! Ne manquez pas de visiter le Carrefour du Collège pour voir notre impressionnante gamme de produits. L’encan silencieux a lieu du jeudi 12 novembre au samedi 14 novembre. Tous les profits soutiennent les initiatives de recherche et d’éducation en médecine familiale. Misez avec le cœur!

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exhibit hall

HALL D’EXPOSITION

The FMF Exhibit Hall is a marketplace that provides delegates the opportunity to interact with exhibitors offering a wide range of products and services. Some may be controversial but all contribute to the dialogue that makes FMF a vibrant intellectual experience. CFPC does not endorse or accept responsibility for the presence of inaccurate or biased materials. We make every effort to ensure that exhibitors abide by professional and ethical standards of behavior and we are confident that our registrants will employ their excellent critical thinking abilities when reviewing the exhibits.

Le Hall d’exposition du FMF est un marché qui permet aux délégués d’interagir avec des exposants, qui offrent un large éventail de produits et services. Certains d’entre eux pourraient s’avérer controversés, mais tous contribuent au dialogue qui fait du FMF une expérience intellectuelle riche et dynamique. Le CMFC n’appuie et n’est pas responsable de toute documentation inexacte ou qui exprime un parti pris. Nous mettons tout en œuvre pour faire en sorte que les exposants respectent des normes de comportement professionnelles et éthiques, et nous sommes persuadés que les délégués feront appel à leur excellent sens critique au moment d’évaluer les kiosques.

The Exhibit Hall complements the clinical and educational activities of FMF with more than 300 booths. Exhibitors provide the most up-to-date information on developments in medical equipment, diagnostics, practice management software, relocation opportunities, pharmaceuticals, patient care, nutrition, and educational publishing. There is a great variety of people and places to visit: • Canadian Forces Mobile Hospital featuring actual field use equipment • Recruiters from across the country • Not-for-profit organizations with focused messages • Affiliated medical associations • Representatives of the family medicine residency programs • Booths featuring new products and devices • Daily Exhibit Hall contest draw • Redesigned College Square, featuring departments from the College of Family Physicians of Canada (CFPC) the Ontario College of Family Physicians (OCFP), the Mainpro Lounge and Member Care Centre where you can learn about CFPC member services • Our exclusive Marketplace, this year including organic chocolate and one-of-a kind gifts And more!

Avec plus de 300 kiosques, le Hall d’exposition du FMF complète les activités cliniques et éducatives du FMF. Les exposants y présentent les derniers renseignements sur les appareils médicaux, les produits diagnostics et pharmaceutiques, les logiciels de gestion de la pratique, les occasions de délocalisation, ainsi que du matériel sur les soins aux patients, l’alimentation et l’édition dans le domaine de l’éducation. Profitez de cette occasion pour visiter une variété de personnes et d’endroits : • Hôpital mobile des Forces canadiennes, avec de l’équipement utilisé sur le terrain • Recruteurs de partout au pays • Organismes sans but lucratif avec leurs messages ciblés • Associations médicales affiliées • Représentants des programmes de résidence en médecine familiale • Kiosques présentant des nouveaux produits et dispositifs médicaux • Tirage quotidien dans le Hall d’exposition • Nouveau Carrefour du Collège – mettant en vedette les départements du Collège des médecins de famille du Canada (CMFC) et du Collège des médecins de famille de l’Ontario (CMFO), le salon Mainpro et le Centre des services aux membres, où vous pourrez vous renseigner sur les services offerts aux membres du CMFC • Notre Marché exclusif – où vous pourrez vous procurer du chocolat biologique et des surprises inimitables Et bien plus encore!

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EXHIBITORS / EXPOSANTS The CFPC collects, uses and discloses personal information in accordance with current privacy legislation and the CFPC privacy policy.

This policy is published in its entirety on its website at www.cfpc.ca Information provided by registrants to exhibitors, is covered by the privacy policy of the individual exhibit company.

Le CMFC recueille, utilise et communique des renseignements personnels conformément à la législation actuelle sur la protection de la vie privée et la politique de confidentialité du CMFC. Le texte intégral de cette politique est publié sur le site Web du CMFC à www.cfpc.ca Lorsque les visiteurs interagissent avec les exposants, ces derniers sont assujettis à la politique de confidentialité de l'entreprese concerné.

The College of Family Physicians of Canada Le Collège des médecins de famille du Canada.........College Square Research and Education Foundation La Fondation pour la recherche et l'éducation...........College Square Ontario College of Family Physicians Le Collège des médecins de famille de l’Ontario.......College Square

ACADEMIC FAMILY MEDICINE MÉDECINE FAMILIALE UNIVERSITAIRE Canadian Resident Matching Service (CaRMS)............................ 143 Dalhousie University . ................................................................ 446 McGill University . ..................................................................... 344 McMaster University................................................................... 442 Memorial University of Newfoundland....................................... 343 Northern Ontario School of Medicine......................................... 246 Queen’s University...................................................................... 247 Resident Doctors of Canada........................................................ 244 University of Alberta .................................................................. 346 University of British Columbia..................................................... 243 University of Calgary................................................................... 242 University of Manitoba................................................................ 245 University of Ottawa................................................................... 347 University of Saskatchewan......................................................... 447 University of Toronto................................................................... 342 Western University...................................................................... 443

ASSOCIATIONS / ASSOCIATIONS Alcoholics Anonymous................................................................ 124 Brain Tumour Foundation of Canada.......................................... M16 CADDRA Inc. (Canadian ADHD Resource Alliance).................... M1 CADTH/ACMTS........................................................................... 527 Canadian Academy of Sport & Exercise Medicine....................... 327 Canadian Association of Emergency Physicians........................... 226 Canadian Association of Physician Assistants.............................. 824 Canadian Association of Physicians for the Environment (CAPE)................................................ 645 Canadian Athletic Therapists Association..................................... 604 Canadian Cardiovascular Society................................................. M2 Canadian Celiac Association....................................................... 730 Canadian Family Practice Nurses Association............................... M5 Canadian Forces Role 2 Field Hospital........................................ 743 Canadian Pharmacists Association.............................................. 120 Canadian Society for Orthomolecular Medicine (CSOM)............ 608 Cancer Care Ontario................................................................... 710 College of Physicians & Surgeons of Ontario Assessor Recruitment............................................ 147 Eczema Society of Canada Société canadienne de l’eczéma........................................ 646 General Practice Psychotherapy Association............................... 724 Hypertension Canada.................................................................. 110 ListenUP Canada......................................................................... 212 Medical Council of Canada......................................................... 145 Myeloma Canada........................................................................ 545 Nurse Practitioners’ Association of Ontario (NPAO).................... 118 Ontario Chiropractic Association................................................ 826 fmf.cfpc.ca

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OMA Section on General and Family Practice........................... M14 Ontario Renal Network............................................................... 708 Parkinson Society Canada........................................................... 825 Prostate Cancer Canada.............................................................. 630 Society of Obstetricians & Gynaecologists of Canada (SOGC).... 302 Tea Association of Canada........................................................... 625 The Canadian Association of Optometrists.................................. 325 The Lung Association.................................................................. 606

EDUCATIONAL SERVICES / SERVICES ÉDUCATIFS AboutKidsHealth........................................................................ M20 BFI Strategy for Ontario.............................................................. M24 Canadian Center for Foreign Professionals................................... M7 Canadian Institute for Health Information (CIHI)......................... 424 Centre for Effective Practice......................................................... 547 Choosing Wisely Canada............................................................. 628 Communimed............................................................................. 822 Exercise is Medicine Canada....................................................... 326 Health Partners International of Canada ..................................... 744 i-GAP – Improving Advance Care Planning in General Practice................................................................ 444 IUD Insertion Training................................................................. 727 Machealth.................................................................................. M12 mdBriefCase.com........................................................................ 812 Pallium Canada.......................................................................... M15 Project ECHO Ontario – Chronic Pain.......................................... M3 Rural Ontario Medical Program.................................................... M9 RxFiles......................................................................................... 603 The Foundation for Medical Practice Education.......................... 644

FINANCIAL INVESTMENT / INVESTISSEMENTS Scotiabank Professional Plan....................................................... 306 Sun Life Financial........................................................................ 723

GOVERNMENT / GOUVERNEMENT Canadian Nuclear Safety Commission ....................................... 207 CTFPHC...................................................................................... 544 Health Quality Ontario............................................................... 610

INSURANCE / ASSURANCE TD Insurance............................................................................... 513

MEDICAL DEVICES / DISPOSITIFS MÉDICAUX Air Liquide Healthcare................................................................ 626 Besins Healthcare Canada........................................................... 704 Diva International Inc.................................................................. 529 Infinite Trading........................................................................... M25 ManthaMed Inc........................................................................... 602 Otto Trading, Inc......................................................................... 229 SeeMore Imaging Canada........................................................... M19 Sigvaris........................................................................................ 629 Surgo Surgical Supply.................................................................. 233 Trimedic Supply Network............................................................ 808 Trudell Medical International...................................................... 642 Valco Products............................................................................ 224 Welch Allyn................................................................................ 636 @familymedforum

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EXHIBITS | EXPOSITION MENTAL HEALTH / SANTÉ MENTALE CBT Associates............................................................................ 430 Homewood Health Centre.......................................................... 205 Mental Health Commission of Canada......................................... M8 Portico Network.......................................................................... 109 Room 217 Foundation................................................................. 611 The Centre for Mindfulness Studies............................................ M22

NATURAL/OVER-THE-COUNTER PRODUITS NATURELS/VENTE LIBRE Bio-Oil........................................................................................ 319 Church & Dwight Canada........................................................... 436 Ddrops Company........................................................................ 317 Proctor & Gamble............................................................ 336 & 337

NUTRITION / NUTRITION Dairy Farmers of Canada............................................................. 711 Egg Farmers of Canada................................................................ 203 Nestlé Nutrition........................................................................... 613

OTHER / AUTRE Canadian Cannabis Clinics.......................................................... 210 ChocoSol Horizontal Traders and Chocolatiers............................ 807 M and M Sales – “Human Touch Dealer”............................Lounge 4 Shop for Jayu............................................................................... 811 Tourism Toronto........................................................................... 106

PHARMACEUTICAL / PHARMACEUTIQUE Amgen Canada............................................................................ 523 AstraZeneca................................................................................ 316 Bayer Inc..................................................................................... 530 Bio-K Plus................................................................................... 622 BioSyent Pharma Inc................................................................... 113 Boiron Laboratories..................................................................... 225 Boehringer Ingelheim (Canada) Ltd............................................. 716 Boehringer Ingelheim Medical Information................................. 712 Calmoseptine, Inc....................................................................... 213 CannTrust Inc.............................................................................. 102 Divigel........................................................................................ 706 Galderma Canada....................................................................... 633 GSK . ........................................................................................ 830 Indivior Canada Ltd..................................................................... 331 Janssen Inc.................................................................................. 517 Lundbeck Canada....................................................................... 416 Medical Futures Inc..................................................................... 330 Medreleaf Medical Cannabis....................................................... 222 Methapharm Inc.......................................................................... 609 Mettrum Health Corporation....................................................... 127 Mylan.......................................................................................... 722 Novo Nordisk Canada – Diabetes............................................... 232 Novo Nordisk Canada – Obesity . .............................................. 332 Paladin Labs................................................................................ 702 Pediapharm.................................................................................. M6 Pendopharm, a Division of Pharmascience Inc........................... 612 Purdue Pharma............................................................................ 333 Sanofi Canada............................................................................. 736 Shire . ........................................................................................ 231 Tilray .......................................................................................... 432 Tyros Biopharma......................................................................... 632 Voltaren Emulgel Extra Strength................................................... 322

PRACTICE MANAGEMENT PRODUCTS AND SERVICES PRODUITS ET SERVICES DE GESTION DE LA PRATIQUE AMS . ........................................................................................ 310 BillOHIP.ca................................................................................. 631 Canada Health Infoway............................................................... 209 Canadian Virtual Hospice............................................................ 425 fmf.cfpc.ca

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CMA/MD Financial Management................................................ 503 Consult Conduit......................................................................... M26 ConsultLoop............................................................................... M28 Crowe Soberman, Healthcare Group......................................... M17 Hofstetter Business Technologies................................................. 616 innoviCares................................................................................. 533 LifeLabs....................................................................................... 643 Malpractice Check...................................................................... 428 MD Circles................................................................................. M27 MNP . ........................................................................................ 112 NorthWest Healthcare Properties................................................ 208 Ocean by CognisantMD.............................................................. 543 Ontario Telemedicine Network (OTN)......................................... 726 OntarioMD.................................................................................. 624 OSCAR EMR................................................................................ 133 RPS Diagnostics.......................................................................... 526 RSRS – Record Storage & Retrieval Services, Inc......................... 223 Supon Voice................................................................................ 123 Telus Health................................................................................ 537 The Community Network............................................................ 114

RECRUITERS / RECRUITEMENT Advanced Medical Group........................................................... 511 Alberta Health Services............................................................... 427 Appletree Medical Group............................................................ 709 Barrie Area Physician Recruitment.............................................. 111 Brant & Niagara.......................................................................... 522 Interior Health Authority – BC..................................................... 725 Canadian Forces Role 2 Field Hospital........................................ 743 City of Thunder Bay (The)............................................................ 713 Delta Division of Family Practice................................................ 728 Dryden Regional Health Centre................................................. M11 Fraser Northwest Division of Family Practice............................... 546 Global Medical Staffing............................................................... 323 Global Medics Physician Recruitment........................................ M23 Government of Nunavut, Department of Health.......................... 312 Halton & Hamilton...................................................................... 522 Hastings County.......................................................................... 329 Health Match BC......................................................................... 531 Imagine Health Centres............................................................... 509 Island Health............................................................................... 542 Jack Nathan Health..................................................................... 423 Kapuskasing & District Recruitment........................................... M21 Kincardine & Saugeen Shores Recruitment................................... M4 Kirkland and District Hospital.................................................... M13 Manitoba’s Office of Rural & Northern Health and Manitoba Health......................................................... 647 MCI The Doctor’s Office™.......................................................... 308 MD Agility................................................................................... 623 MDSearch Canada...................................................................... 507 Northern Medical Services.......................................................... 605 Nova Scotia Department of Health & Wellness........................... 426 NZLocums................................................................................... 618 Province of New Brunswick........................................................ 132 Rexall . ........................................................................................ 732 saskdocs...................................................................................... 607 Sioux Lookout Regional Physician Services................................. 746 Surrey-North Delta Division of Family Practice........................... 227 Thompson Region Division of Family Practice............................ 627 Town of Smiths Falls................................................................... M10 Weeneebayko Health – Moose Factory....................................... 211 Your Doctor Jobs ....................................................................... M18 YukonMD.................................................................................... 742

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EXHIBIT HALL FLOOR PLAN Metro Toronto Convention Centre, South Building, Hall E Show Office

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Academic Medicine 647

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Canadian Forces Role 2 Field Hospital Hôpital de campagne de rôle 2 des Forces canadiennes

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Médecine universitaire

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SALON DES EXPOSANTS

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LOUNGE SALON

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Astra Zeneca

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126

AISLE / ALLÉE 100

M12 M11

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M26 M25

AISLE / ALLÉE 700

M28 M27

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5

AISLE / ALLÉE 200

830

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P&G

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636

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736

M16 M15 M14 M13

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M20 M19 FOOD AND BEVERAGE

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M22 M21

AISLE / ALLÉE 400

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M24 M23

124

120 118

LOUNGE SALON

114 STAGE 4' x 6'

812 UP

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THEATRE | THÉÂTRE entrance

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CFPC

THE COLLEGE OF FAMILY PHYSICIANS OF CANADA

CMFC

LE COLLÈGE DES MÉDECINS DE FAMILLE DU CANADA

312

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Silent Auction Encan silencieux

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LOUNGE SALON

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EXHIBITS ENTRANCE EXPOSITION  ENTRÉE

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KEYNOTE ROOM SALLE DES CONFÉRENCES D’OUVERTURE

EXHIBITS | EXPOSITION AboutKidsHealth www.aboutkidshealth.ca

#M20

Alcoholics Anonymous www.aa.org

#124

AboutKidsHealth.ca is a world-renowned non-profit information source for children’s health from The Hospital for Sick Children (SickKids) in Toronto.

All of the content is developed in collaboration with pediatric specialists at SickKids. Discover over 3,000 pages of child health content that can be shared with patients and their families.

Alcoholics Anonymous is a worldwide fellowship of sober alcoholics, whose recovery is based on Twelve Steps. There are no dues or fees; AA is selfsupporting through voluntary, small contributions of members, accepts no outside funds, and is not affiliated with any other organization. Our primary purpose: to carry the AA message to alcoholics who still suffer.

AboutKidsHealth.ca est une source d'information à but non lucratif sur la santé des enfants de classe mondiale provenant de l'Hôpital pour enfants de Toronto. Tout le contenu est élaboré en collaboration avec des spécialistes pédiatriques à l’hôpital SickKids. Découvrez plus de 3 000 pages de renseignements sur la santé des enfants à partager avec vos patients et leurs proches.

Alcooliques Anonymes est un mouvement international d'alcooliques abstinents dont le rétablissement se base sur Douze Étapes. Nous n'exigeons aucun frais ou cotisations et n’acceptons aucuns fonds extérieurs, car nous nous autofinancions au moyen de modestes contributions volontaires de nos membres. Nous ne sommes affiliés à aucun autre organisme, et notre but principal est d'apporter le message AA aux alcooliques en souffrance.

Advanced Medical Group www.advancedmedicalgroup.net

#511 Contest Contribution: Fitbit

Advanced Medical Group (AMG) is a collaboration of medical professionals in conjunction with senior supportive care.

This state-of-the-art 160,000-square-foot complex is located in London, Ontario, with plans for expansion nationally. The four-storey AMG will house 36 family doctors, 18 specialists, plus 12 allied health professionals—all collaborating through one Electronic Medical Record. The focus is a lifestyle approach to medicine—improving patient health through participatory medicine.

Advanced Medical Group est un groupe de professionnels de la santé qui exercent en collaboration avec des soins de soutien aux aînés. Notre centre ultramoderne de 160 000 pieds carrés est situé à London (Ontario); nous planifions une expansion à l'échelle nationale. Notre centre de quatre étages regroupera 36 médecins de famille, 18 spécialistes et 12 autres professionnels de la santé qui travaillent ensemble grâce à un seul DMÉ. Nous apportons une approche axée sur le mode de vie afin d’améliorer la santé des patients au moyen de la médecine participative.

Air Liquide Healthcare www.airliquidehealthcare.ca

#626 Contest Contribution: Cash

Air Liquide Healthcare (ALH) is a world leader in medical gases. The College of Physicians and Surgeons in Ontario recommends every GP should carry emergency oxygen in their office emergency equipment. ALH’s new QuickFLO2 is a disposable, portable, simple, safe medical oxygen cylinder with an integrated regulator.

Air Liquide Healthcare (ALH) est un chef de file mondial en gaz médicaux.

Le College of Physicians and Surgeons in Ontario recommande à chaque médecin généraliste d’inclure l'oxygène de secours dans son équipement d'urgence au bureau. Le nouveau QuickFLO2 est un cylindre d'oxygène médical jetable, portatif, simple et sûr, muni d’un régulateur intégré.

Alberta Health Services www.calgaryfamilymedicine.ca

#427

Stop by our Alberta Health Services booth to discuss family medicine practice opportunities for all five geographical zones in Alberta. Come discover diverse practice options including community family practice, family medicine emergency, hospitalist, academic teaching, and much more in both rural and urban settings. We look forward to meeting with you!

Amgen Canada www.amgen.ca

#523

Amgen Canada discovers, develops, manufactures, and delivers innovative human therapeutics. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cardiovascular disease, bone disease, cancer, kidney disease, rheumatoid arthritis, and other serious illnesses.

Amgen Canada découvre, développe, produit et distribue des produits thérapeutiques à usage humain novateurs. Les produits thérapeutiques Amgen ont changé la manière de pratiquer la médecine, en aidant des millions de patients dans le monde entier à combattre la maladie cardiovasculaire, les maladies osseuses, le cancer, les maladies rénales, la polyarthrite rhumatoide ou d'autres maladies graves.

AMS www.theamsphoenix.ca

#310

AMS is a charitable organization with an impressive history as a catalyst for change, impacting the health care of Canadians through its support of the history of health care, health professional education, and compassionate patient care. The AMS Phoenix Project aims to make a difference in how health professionals nurture and sustain their abilities to provide compassionate care.

AMS est un organisme de bienfaisance avec une histoire impressionante en tant que moteur de changements positifs et importants pour la santé des Canadiens. Il y parvient grâce à son soutien pour l’histoire des soins de santé, la formation des professionels de la santé et la prestation de soins avec compassion. Le projet Phoenix d’AMS vise à faire une différence dans la manière dont les professionels de la santé cultivent et maintiennent leurs capacités à fournir les soins avec compassion.

Appletree Medical Group www.appletreemedicalgroup.com

#709

Appletree Medical Group is one of the largest and most progressive medical groups in Canada. With 35 clinics across Ottawa and the GTA, our multidisciplinary teams of family doctors and specialists enjoy practising in our modern offices well equipped with diagnostic tools, a highly trained, professional staff, and a top EMR. Appletree Medical Group est un des groupes médicaux les plus importants et les plus novateurs au Canada. Avec 35 cliniques à Ottawa et dans la région du Grand Toronto, nos équipes multidisciplinaires de médecins de famille et de spécialistes ont à leur disposition des bureaux modernes, bien équipés d'outils diagnostiques, un personnel hautement qualifié et professionel ainsi que des DMÉ des plus performants.

Visitez le kiosque de l’Alberta Health Services afin de discuter des opportunités pour l’exercice de médecine familiale dans les cinq zones géographiques de l'Alberta. Venez découvrir les diverses options de pratique, telles que la pratique de médecine familiale communautaire, les soins d'urgence, la médecine hospitalière et l'enseignement universitaire ainsi que d’autres possibilités dans les milieux ruraux et urbains. Nous serons heureux de vous rencontrer!

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EXHIBITS | EXPOSITION AstraZeneca www.astrazeneca.ca

#316

At AstraZeneca Canada we strive to deliver great medicines to patients through innovative science. But managing disease can’t be done with medicines alone. Together we can develop creative solutions to help tackle the challenges of effectively preventing and treating disease. We are proud to sponsor the 2015 FMF, as part of our commitment to supporting Canada’s health care community.

Chez AstraZeneca Canada, nous nous efforçeons de fournir des médicaments de qualité aux patients au moyen de solutions scientifiques novatrices.

Pourtant, la gestion des maladies ne peut être réalisée uniquement que par les médicaments. Ensemble, nous pouvons élaborer des solutions novatrices afin d’aider à relever les défis relatifs à la prevention et au traitement des maladies. Nous sommes fiers de parrainer le FMF 2015, dans le cadre de notre engagement à soutenir la communauté des soins de santé au Canada.

Barrie Area Physician Recruitment www.barriedoctors.ca

#111

The Barrie Area, located in famous cottage country just north of Toronto, is one of Canada’s most dynamic regions. Our team of over 390 skilled physicians includes 80+ family physicians who enjoy a wide variety of practice. The Family Health Organization together with the Family Health Team is one of the largest in Ontario, with 86 physicians and 50+ health professionals providing care to over 140,000 patients.

Barrie et ses environs, situés au cœur de la région de villégiature renommée au nord de Toronto, comptent parmi les endroits les plus dynamiques au Canada. Notre équipe de 390 médecins compétents, dont 80 médecins de famille, exercent dans divers domaines de pratique. Avec 86 médecins et plus de 50 professionnels de la santé, l'Organisme de santé familiale, de concert avec l'Équipe de santé familiale, est lun des plus importants en Ontario et fournit des soins de santé à plus de 140 000 patients.

Bayer Inc. www.bayer.ca

#530

As an inventor company, Bayer creates innovative products, breakthrough treatments, and healthier alternatives to improve the quality of life for people, animals, and communities. We put science to work in the vital areas of health, nutrition, and high-tech materials, both across Canada and around the world.

Entreprise innovatrice, Bayer crée des produits novateurs, des traitements révolutionnaires et des solutions saines qui améliorent la vie des gens, des animaux et des communautés. Nous mettons la science à profit dans les domaines de la santé, de la nutrition et des matériaux de haute technologie, au Canada et ailleurs dans le monde.

Besins Healthcare Canada www.besinshealthcare.ca

#704 Contest Contribution: Cash

Besins Healthcare Canada has recently launched two new products in women’s health. Femarelle offers significant relief of menopausal symptoms and supports bone health. Relactagel provides relief and prevention of the symptoms of bacterial vaginosis. Please visit our booth for more information on these new products as well as our Mona Lisa IUDs. Soins de santé Besins a récemment lancé deux nouveaux produits pour la santé des femmes. Femarelle offre un soulagement significatif des symptômes de la ménopause et soutient la santé osseuse. Relactagel peut soulager et prévenir les symptômes de la vaginose bactérienne. Venez visiter notre kiosque pour plus d'informations sur ces nouveaux produits ainsi que sur nos stérilets Mona Lisa.

BFI Strategy for Ontario www.tegh.on.ca/bfistrategy

#M24

The BFI Strategy for Ontario is a project funded by the Ministry of Health and Long-Term Care and led by Toronto East General Hospital. You are invited to visit our display to learn about the WHO Baby-Friendly Initiative and hear about tools and supports available to support family physicians in adopting baby-friendly evidence-based best practices.

La Stratégie sur l'Initiative Amis des bébés de l'Ontario est un projet financé par le ministère de la Santé et des Soins de longue durée et dirigé par l'Hôpital général de Toronto-Est. Vous êtes invités à consulter notre kiosque pour en apprendre davantage sur l'Initiative Amis des bébés de l'OMS et connaître les outils et les mesures de soutien récemment mis sur pied pour aider les médecins de famille à adopter des pratiques exemplaires qui répondent aux exigences de l'IAB.

billOHIP.ca billohip.ca

#631

billOHIP.ca is an app designed to simplify your billing practice, whether you do your own billing or work with a billing agent. Electronically record, store, share, and submit your billing for free! To help, billOHIP.ca automatically generates your most common fee codes and calculates your earnings in real time. billOHIP.ca est une application conçue pour simplifier la facturation, que vous fassiez votre propre facturation ou que vous travailliez avec une agence de facturation. Enregistrez, sauvegardez, partagez et soumettez votre facturation gratuitement par voie électronique. Pour vous aider, billOHIP.ca génère automatiquement vos codes de facturation les plus communs et calcule vos revenus en temps réel.

Bio-K Plus www.biokplus.com

#622

Bio-K+ is a unique patent-protected and clinically proven probiotic formula of L. acidophilus CL1285® , L. casei LBC80R®, and L. rhamnosus CLR2®. This probiotic formula is certified gluten free and offered in various flavours in fermented milk, soy, and organic sprouted brown rice. It is also available in enteric-coated capsules.

La formule probiotique unique, brevetée et éprouvée en clinique Bio-K Plus comprend le L.acidopholus CL1285®, le L.casei LBC80R® et le L.rhamnosus CLR2®. Cette formule Certifié sans gluten est offerte en diverses saveurs telles que le lait fermenté, le soya et le riz brun germé certifié biologique. Elle est aussi disponible avec enrobage entérosoluble.

Bio-Oil www.bio-oil.com

#319

Bio-Oil is Canada’s #1 selling scar and stretch mark product. Bio-Oil’s unique blend of natural plant oils and vitamins is non-greasy, rapidly absorbed, and suitable for all skin types. Bio-Oil is also effective against other skin concerns like uneven skin tone, aging, and dehydrated skin.

Bio-Oil est le produit pour les vergetures et les cicatrices le plus vendu au Canada. Son mélange unique d'huiles de plantes naturelles et de vitamines non gras s’absorbe rapidement et convient à tous les types de peau. Bio-Oil est aussi efficace pour d’autres problèmes de peau, comme le teint irrégulier, le vieillissement et la déshydratation.

BioSyent Pharma Inc. www.biosyent.com

Booth: 113 Contest Contribution: Cash

BioSyent is a fast-growing Canadian company listed on the TSX Venture Exchange (TSXV:RX) that sources the globe for innovative products that improve the lives of patients and supports the health care professionals that treat them.

For more information about BioSyent Pharma Inc. visit www.biosyent.com.

En pleine croissance, BioSyent, inscrit à la bourse de croissance TSX (TSXV :RX) est une entreprise pharmaceutique spécialisée dans l’approvisionnement et la commercialisation de produits novateurs destinés à améliorer la vie des patients et à soutenir les professionnels de santé dans leurs fonctions. Pour plus d’informations sur BioSyent Pharma Inc. visitez www.biosyent.com.

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EXHIBITS | EXPOSITION Boehringer Ingelheim (Canada) Ltd. www.boehringer-ingelheim.ca

#712 & 716

Boehringer Ingelheim is committed to the development of innovative, cost-effective medicines that fulfill unmet medical needs. Our drug discovery focuses on immunology and respiratory diseases, oncology, cardiometabolic diseases, and diseases of the central nervous system. Our Canadian operations have been based in Burlington since 1978 with more than 550 employees across Canada.

Boehringer Ingelheim se consacre à la mise au point de médicaments innovateurs rentables répondant aux besoins médicaux actuels. Nous nous concentrons sur les maladies immunologiques, respiratoires, cardiométaboliques, oncologiques et du système nerveux central. Située à Burlington depuis 1978, l’entreprise compte plus de 550 employés à l’échelle du pays.

Boiron Laboratories www.boiron.ca

#225

Boiron is a pharmaceutical company with over 80 years of experience in manufacturing homeopathic medicines. Boiron Canada provides health care practitioners and consumers with gentle, reliable, and effective treatments for cough, cold, and flu-like symptoms; muscle pain; and baby ailments since 1988.

Les Laboratoires Boiron sont une entreprise comptant 80 ans d’expérience dans la fabrication de médicaments homéopathiques. Boiron Canada propose une gamme de médicaments pour le traitement des symptômes de la toux, des états grippaux, douleurs articulaires et musculaires ainsi que des maux de bébé dupuis 1988.

Brain Tumour Foundation of Canada www.braintumour.ca

#M16

Our dedicated team of volunteers, patients, survivors, family members, health care professionals, and staff is determined to make the journey with a brain tumour one full of hope and support. We work collaboratively to serve the needs of all Canadians affected by all types of brain tumours by offering support services, education, information, and funding research.

Nous sommes un groupe de bénévoles, de patients, de survivants, de membres de famille, de professionels de la santé et de personnel déterminé à offrir de l'espoir et du soutien à tous ceux qui sont touchés par une tumeur cérebrale. Nous travaillons en collaboration afin de répondre aux besoins de tous les Canadiens touchés par tous les types de tumeurs cérébrales au moyen de services de soutien, de l'information, de l'éducation et de la recherche.

Brant & Niagara #522 www.niagaradocs.ca; www.bchsys.org; www.haltondoctors.ca; www.hamiltonphysicians.ca Contest Contribution: Cash Discover the opportunities for family physicians in Brantford-Brant, Halton, Hamilton, and Niagara: centres for innovation, teaching and research, and home to the renowned McMaster University. Enjoy the natural beauty of our vineyards, orchards, waterfalls, and trails, as well as vibrant arts and entertainment—the perfect blend of rural and urban.

Découvrez les possibilités offertes aux médecins de famille à Brantford-Brant, Halton, Hamilton et Niagara; les centres d’innovation, d’enseignement et de recherche, et le site de la réputée Université McMaster. Profitez de la beauté naturelle de nos vignobles, vergers, chutes et sentiers, de la richesse des arts et spectacles – mélange parfait des modes de vie urbain et rural.

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British Columbia Interior Health Authority www.betterhere.ca

#725

FPs in Interior Health provide services to 749,600 residents in BC’s sunny Southern Interior. Opportunities are available for FPs interested in clinic practice as well as those with emergency, anesthesia, obstetrics, and surgery training. Urban and rural locations offer exceptional lifestyle and recreation.

Les médecins de famille de la régie de la santé du Centre de la C.-B. offrent des services à 749 600 résidants de cette région intérieure du sud de la province. Des possibilités sont offertes aux MF intéressés par une pratique en clinique ainsi qu’à ceux qui ont une formation en anesthésie, en médecine d’urgence, en obstétrique et en chirurgie. Des emplacements urbains et ruraux offrent des choix exceptionnels de modes de vie et de loisirs.

CADDRA Inc. (Canadian ADHD Resource Alliance) #M1 www.caddra.ca CADDRA (Canadian ADHD Resource Alliance) is a non-profit, multidisciplinary alliance of health care professionals working in the field of ADHD. It produces the Canadian ADHD Practice Guidelines, which includes the ADHD Assessment Toolkit designed for primary care practice. CADDRA provides professional training on ADHD and hosts an annual conference.

CADDRA (Canadian ADHD Resource Alliance) est un regroupement à but non lucratif et multidisciplinaire de professionnels des soins de santé qui travaillent dans le domaine du TDAH. Elle prépare les Lignes directrices canadiennes pour le TDAH, qui comprennent une trousse pour l’évaluation du TDAH, conçue pour la pratique des soins primaires. CADDRA offre la formation professionnelle dans le domaine du TDAH et organise une conférence annuelle.

CADTH/ACMTS www.cadth.ca

#527

CADTH helps family doctors put evidence into practice. For 25 years CADTH has been providing balanced and independent evidence, recommendations, and advice—all freely available at www.cadth.ca. Visit our booth to see our work on primary care topics such as diabetes, stroke prevention in atrial fibrillation, lab tests, and more.

L’ACMTS aide les médecins de famille dans leur pratique. Instituée il y a 25 ans, l’ACMTS offre des données fondées et indépendantes, des recommandations et des conseils – le tout accessible gratuitement sur le site www.acmts.ca. Venez visiter notre kiosque pour mieux connaitre notre travailsur les soins primaires, comme le diabète, la prévention de l’AVC chez les personnes atteintes de fibrillation auriculaire, les essais en laboratoire et bien d’autres.

Calmoseptine, Inc. www.calmoseptine.com

#213

Calmoseptine® Inc. promotes Calmoseptine® Ointment for the prevention and treatment of skin irritations from moisture such as urinary and fecal incontinence. It is also effective for irritations from perspiration, wound drainage, fecal and vaginal fistulas, and feeding tube site leakage.

Calmoseptine® Ointment temporarily relieves discomfort and itching. Free samples at our booth!

Calmoseptine Inc fait la promotion de Calmoseptine® Ointment, pour la prévention et le traitement des irritations cutanées dues à la moiteur causée par l'incontinence urinaire et fécale. Il est également efficace dans le traitement des irritations causées par la transpiration, le drainage des plaies, les fissures fécales et vaginales ainsi que les fuites du tube d'alimentation.

Calmoseptine® Ointment fournit le soulagement temproraire de l'inconfort et des démangeaisons. Visitez notre kiosque pour obtenir des échantillons gratuits!

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EXHIBITS | EXPOSITION Canada Health Infoway www.infoway-inforoute.ca

#209 Contest Contribution: Cash

Infoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption, and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government.

Inforoute contribue à améliorer la santé des Canadiens et Canadiennes en travaillant avec ses partenaires pour accélérer le développement, l'adoption et l'usage efficace de la santé numérique au Canada. Grâce à nos investissements, nous fournissons aux patients et aux cliniciens un meilleur accès aux soins et des services de santé plus efficaces. Inforoute est une organisation indéendante et à but non lucratif financée par le gouvernement du Canada.

Canadian Association of Physicians for the Environment (CAPE) www.cape.ca

This doctors’ organization protects our health by protecting the planet. We are currently working to protect pollinators from toxic neonicotinoid pesticides and to prevent disease and mitigate climate change by closing down coal plants. Visit our booth or our website to learn more and become a CAPE member today!

Cet organisme de médecins protège notre santé en protégeant la planète. À l’heure actuelle, nous travaillons afin de protéger les pollinisateurs des pesticides néonicotinoïdes toxiques. Nous tentons également de prévenir les maladies et d’atténuer les changements climatiques au moyen de la fermeture des centrales au charbon. Visitez notre stand ou notre site afin d'en apprendre davantage et devenez un membre de l’Association Canadienne des Médecins pour l’Environnement dès aujourd'hui!

Canadian Athletic Therapists Association www.athletictherapy.org

Canadian Academy of Sport and Exercise Medicine #327 www.casem-acmse.org

Contest Contribution: Cash

L’Académie canadienne de la médecine du sport et de l’exercice (ACMSE) est une organisation composée de médecins dévoués à l’excellence de la pratique de la médecine appliquée à tous les aspects de l’activité physique.

#226

Contest Contribution: Gift cert for CAEP CAEP is a member-based association that has been advocating for emergency physicians and their patients since 1978.

The mission for CAEP is to advocate for emergency physicians and their patients, connect emergency physicians, provide leading emergency medicine education, and provide a forum for research in emergency medicine.

L'Association canadienne des médecins d'urgence (ACMU) est une association qui défend les droits des médecins d'urgence et de leurs patients depuis 1978. Sa mission est de militer en faveur des médecins d’urgence et leurs patients, de faciliter la communication entre médecins d'urgence et de fournir une éducation en médecine d'urgence de premier plan et un forum pour la recherche dans ce domaine.

Canadian Association of Physician Assistants www.capa-acam.ca

#824

The Canadian Association of Physician Assistants is a nationally incorporated bilingual professional association that advocates on behalf of its members across Canada and internationally. CAPA has members in all national regions as well as the Canadian Forces sharing a desire to help develop Canadian health care, and to advocate for the profession’s model of cooperative, collaborative, patient-centred quality health care.

L'Association canadienne des adjoints au médecin est une association professionnelle bilingue, constituée à l'échelle nationale, qui défend les intérêts de ses membres partout au Canada et à l'étranger. Nos membres, qui représentent toutes les régions du pays ainsi que les Forces canadiennes, partagent un même désir d'aider à développer les soins de santé au Canada et de promouvoir le modèle de notre profession : des soins de santé de qualité axés sur la coopération, la collaboration et le patient.

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#604

Certified Athletic Therapists, CAT(C)s, are skilled in the prevention, emergency and acute care, assessment, and rehabilitation of musculoskeletal injuries. A leader in the sports medicine community, the Canadian Athletic Therapists Association is a progressive non-profit organization dedicated to the promotion and delivery of the highest quality care to active Canadians.

The Canadian Academy of Sport and Exercise Medicine (CASEM) is an organization of physicians committed to excellence in the practice of medicine as it applies to all aspects of physical activity.

Canadian Association of Emergency Physicians www.caep.ca

#645

Les thérapeutes du sport agréés (CAT(C)) sont compétents dans la prévention des blessures, les services d’urgence et aigus, ainsi que les techniques d’évaluation et de réadaptation des blessures musculo-squelettiques. Chef de file dans le domaine de la médecine du sport, l’Association canadienne des thérapeutes du sport est un organisme sans but lucratif progressif dévoué à la promotion et à la prestation de soins de la plus haute qualité aux Canadiens actifs.

Canadian Cannabis Clinics www.cannabisclinics.ca

#210

With nine locations across Ontario, Canadian Cannabis Clinics is the leader in cannabis medicine. Our doctors carefully assess patients to determine whether cannabis may be a suitable option where conventional treatments have failed. For a referral form and to learn more visit us at Booth 210.

Avec 9 emplacements à travers l'Ontario, Canadian Cannabis Clinics est un leader du domaine du cannabis thérapeutique. Nos médecins évaluent les patients soigneusement afin de déterminer si le cannabis peut leur être bénéfique dans les cas où les traitements conventionnels ont échoué. Pour en apprendre davantage et obtenir un formulaire de référence, visitez-nous au kiosque 210.

Canadian Cardiovascular Society www.ccs.ca

#M2

The Canadian Cardiovascular Society (CCS) promotes cardiovascular health and care through knowledge translation and professional development. Visit the CCS booth to learn about our clinical guidelines, apps, and educational events, and pick up our handy pocket guides on heart failure, atrial fibrillation, and dyslipidemia management.

La Société canadiene de cardiologie (SCC) fair la promotion de la santé et des soins cardiovasculaires au moyen du transfert de connaissances et du développement professionel. Visitez notre kiosque afin d'apprendre davantage sur nos lignes directrices, nos applications et nos activités éducatives. Nous vous offrons également des guides de poche sur l'insuffisance cardiaque, la fibrillation auriculaire et la prise en charge de la dyslipidémie.

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EXHIBITS | EXPOSITION Canadian Celiac Association www.celiac.ca

#730

The Canadian Celiac Association works to improve diagnosis and treatment for people with celiac disease and other medical issues related to gluten.

Celiac disease is the most common autoimmune disease worldwide. Stop by the CCA booth for the latest diagnostic algorithms and recommendations for ongoing care after diagnosis.

L'Association canadienne de la maladie cœliaque travaille à améliorer le processus de diagnostic et le traitement de personnes souffrant de la maladie coeliaque et d’autres problèmes de santé liés au gluten. La maladie coeliaque est la maladie auto-immune la plus répandue au monde. Visitez notre kiosque pour en apprendre davantage sur les derniers algorithmes de diagnostic et les recommandations pour les soins continus suivant le diagnostic.

Canadian Center for Foreign Professionals www.ccfpmg.com

#M7

CCFPMG provides preparatory courses for medical licensing exams such as MCCEE, MCCQE1 & 2, NAC-OSCE, & USMLE; assistance in preparing/ submitting residency application to CaRMS and residency interview preparation; preparatory courses for certification/board exams, eg, CCFP (SAMPS/SOOS) for current residents; and medical practice management and relocation solutions for physicians.

Le CCFPMG fournit des cours préparatoires pour les examens médicaux tels que l’EECMC, l’EACMC, partie I et partie II, le NAC-OSCE et l’USMLE; de l'assistance à la préparation et à la présentation des demande de résidence au CaRMS ainsi qu’aux entrevues de résidence. Nous offrons également des cours préparatoires pour les examens de certification et d'admission, dont le CCMF (SAMPS/ÉMS) pour les résidents actuels et des solutions destinées aux médecins pour la gestion de la pratique médicale et les déménagements.

Canadian Family Practice Nurses Association www.cfpna.ca

#M5

CFPNA is a professional nursing association affiliated with the Canadian Nurses Association. We advocate for nurses in family practice settings to work to their fullest scope of practice, providing continuing education and networking opportunities to support nurses in their roles.

L'Association canadienne des infirmières en médecine familiale (ACIMF) est une association professionelle d'infimières et d'infirmiers affiliée à l'Association des infirmières et infirmiers du Canada. Nous représentons les intérêts des infirmières et infirmiers afin qu’ils puissent travailler à leur plein potentiel dans leurs contextes de médecine familiale. Nous leur fournissons une formation continue et des possibilités de réseautage afin de les soutenir dans leurs rôles respectifs.

Canadian Forces Role 2 Field Hospital Booth #743 Hôpital de campagne de rôle 2 des Forces canadiennes The Canadian Armed Forces is required to operate anywhere in the world.

Whether in combat or providing humanitarian aid, health care remains a formidable challenge. Natural disasters are occurring more frequently and require a substantive and immediate response to ensure relief to affected nations. The Role 2 Basic is a high readiness capability held by the Canadian Armed Forces that can deploy globally on 24 hours’ notice. It can perform trauma resuscitation and surgery, while offering a small holding capacity for surgical/trauma patients. Its capability includes: • • • • • • • •

2 x Resuscitation bays 1 x Operating Room 2 x Recovery beds 8 x Ward beds Specific diagnostics and imaging Equipment sterilization A command post and headquarters elements Evacuation and Transfer

de préavis. Il permet de dispenser des soins de réanimation à la suite des traumatismes ainsi que des chirurgies, et peut accueillir un petit nombre de patients qui souffrent de traumatisme ou qui ont subi une chirurgie. Il comprend : • • • • • • • •

2 x baies de ressuscitation 1 x salle d'opération 2 x lits de rétablissement 8 x lits d'infirmerie Des capacités de diagnostic et d’imagerie particuliers Stérilisation de l'équipement Poste de commandement et éléments du quartier général Évacuation et transfert

Cette installation d’une grande souplesse représente pour le Canada une unité d’intervention rapide dotée de capacités chirurgicales lui permettant de répondre dans n’importe milieu opérationnel au monde.

Canadian Institute for Health Information (CIHI) www.cihi.ca

#424

The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health system and the health of Canadians. Our stakeholders use our broad range of health databases, measurements, and standards, together with our evidence-based reports and analyses, in their day-to-day decision making. We protect the privacy of Canadians by ensuring the confidentiality, integrity, and availability of our health care information.

L’Institut Canadien d'Information sur la Santé (ICIS) est un organisme autonome et sans but lucratif qui fournit une information essentielle sur le système de santé au Canada et la santé des Canadiens. Nos intervenants utilisent notre vaste gamme de base de données, de mesures et de normes sur la santé, en parallèle avec nos rapports et analyses fondés sur des données probantes, dans leurs décisions courantes. Nous sommes engagés à protéger la vie privée des Canadiens en assurant la confidentialité, l’intégrité et l’accessibilité de nos renseignements sur la santé.

Canadian Nuclear Safety Commission www.nuclearsafety.gc.ca

#207

The CNSC regulates the use of nuclear energy and materials to protect health, safety, security, and the environment, and to implement Canada’s international commitments on the peaceful use of nuclear energy. Come meet the people who make that possible.

La Commission canadienne de sûreté nucléaire réglemente l’utilisation de l’énergie et des matières nucléaires afin de préserver la santé, la sûreté et la sécurité des Canadiens, de protéger l’environnement et de respecter les engagements internationaux du Canada à l’égard de l’utilisation pacifique de l’énergie nucléaire. Venez rencontrer les gens qui rendent cela possible.

Canadian Pharmacists Association www.pharmacists.ca

#120

The Canadian Pharmacists Association improves the health of Canadians by providing evidence-based drug and therapeutic information resources to health care professionals.

L'Association des pharmaciens du Canada améliore la santé des Canadiens en fournissant aux professionnels de la santé des ressources d'information fondées sur les données probantes pour ce qui est des médicaments et des thérapies.

Canadian Resident Matching Service (CaRMS) www.carms.ca

#143

This highly flexible facility provides Canada with a rapid response, surgical capability, able to respond to any operating environment around the world.

The Canadian Resident Matching Service (CaRMS) is a national, not-for-profit, fee-for-service organization established in 1969 at the request of medical students seeking an independent entity to provide a fair and transparent application and matching service for entry into postgraduate medical training throughout Canada. CaRMS staff will be on hand to answer questions about the organization.

Les Forces armées canadiennes doivent être en mesure d'opérer n'importe où au monde. La prestation des soins présente un énorme défi, que ce soit dans les missions de combat ou d'aide humanitaire. Des catastrophes naturelles se produisent plus fréquemment et cela demande de notre part une réponse immédiate et significative afin d'apporter de l'aide aux sinistrés. L’hôpital de campagne de rôle 2 (de base) des Forces canadiennes offre un niveau de disponibilité élevé et peut être déployé dans le monde entier sur 24 heures

Le Service canadien de jumelage des résidents (CaRMS) est un organisme national sans but lucratif opérant en vertu du principe de la rémunération des services, établi en 1969 à la demande d’étudiants en médecine à la recherche d’une entité indépendante pour offrir un service de candidature et de jumelage équitable et transparent concernant les programmes de formation médicale postdoctorale partout au Canada. Le personnel du CaRMS sera sur place pour répondre aux questions à propos de l’organisation.

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EXHIBITS | EXPOSITION Canadian Society for Orthomolecular Medicine (CSOM) www.csom.ca

#608

La Canadian Society for Orthomolecular Medicine est la principale organisation médicale, professionnelle et multidisciplinaire qui se consacre à l'avancement de la médecine orthomoléculaire et nutritionnelle au Canada. Grâce à la publication de données cliniques et des initiatives d'éducation médicale continue, la société soutient la pratique de la médecine orthomoléculaire et nutritionnelle.

#425

The Canadian Virtual Hospice is Canada’s most comprehensive knowledge platform on palliative and end-of-life care, loss, and grief, actively disseminating evidence-informed knowledge to patients, families, health care providers, educators, and researchers. It has been ranked one of the best health websites in Canada by the Canadian Health Libraries Association.

Le Portail canadien en soins palliatifs est la plateforme Internet la plus exhaustive au Canada sur les soins palliatifs et de fin de vie, sur le deuil et la perte. Nous diffusons activement des renseignements fondés sur des données probantes aux patients et à leurs proches, aux professionnels de la santé, aux chercheurs et aux enseignants. Notre site a été classé parmi les meilleurs sites Web sur la santé au Canada par l'Association des bibliothèques de la santé du Canada.

75 M=0 Y=100 K=0

Cancer Care Ontario www.cancercare.on.ca

#710

PANTONE DS 282-1c

Cancer Care Ontario, a division within CCO, drives improvement in cancer 90 M=35 Y=100 K=25 PANTONE DS 281-1c care and delivery of services. We will strive to reduce the number of cancer diagnoses in Ontario while continually improving cancer care and services PANTONE 1505 C for the citizens of Ontario.

Action Cancer Ontario, division au sein du ACO, milite pour l'amélioration du traitement du cancer et la prestation des soins. Nous nous efforcerons de réduire le nombre de diagnostics de cancer en Ontario tout en continuant d’améliorer la prestation des soins du cancer pour les citoyens de cette province.

CannTrust Inc. www.canntrust.ca

#430

Contest Contribution: Books (Mind Over Mood, DSM Pocket Guide)

The Canadian Society for Orthomolecular Medicine is the primary multidisciplinary professional medical organization dedicated to the advancement of orthomolecular and nutritional medicine within Canada.

Through the provision of continuing medical education programs and clinical resources, the society supports those dedicated to the practice of orthomolecular and nutritional medicine.

Canadian Virtual Hospice www.virtualhospice.ca

CBT Associates www.cbtassociates.com

#102 Contest Contribution: Vaporizer

At CBT Associates, we assess and treat children, adolescents, adults, and couples with mood and anxiety disorders, including major depression, bipolar disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, post-traumatic stress disorder, eating disorders, and much more.

Chez CBT Associates, nous évaluons et traitons les enfants, les adolescents, les adultes et les couples souffrant de troubles de l'humeur et de l'anxiété, tels que la dépression majeure, le trouble bipolaire, le trouble panique, le trouble obsessionnel-compulsif, le trouble d'anxiété sociale, les phobies spécifiques, le trouble d'anxiété généralisé, le trouble de stress post-traumatique, les troubles alimentaires et beaucoup plus.

Centre for Effective Practice www.effectivepractice.org

#547

Contest Contribution: Gift cards - Chapters Centre for Effective Practice (CEP) is a federally incorporated, not-for-profit organization that enables appropriate care through the development and implementation of evidencebased programs and tools. CEP has developed expertise in assessing care gaps and the quality of evidence, synthesizing evidence-based recommendations for best clinical practice, and providing advisory services for evidence implementation initiatives.

Le Centre for Effective Practice (CEP) est un organisme à but non lucratif constitué en vertu de la loi fédérale, qui favorise la prestation de soins appropriés par l’entremise du développement et de la mise en oeuvre d'outils et de programmes basés sur les données probantes. Le CEP a développé une expertise dans l'évaluation des lacunes dans la prestation des soins et la qualité des données probantes, la synthétisation de recommandations fondées sur les données probantes pour améliorer la pratique clinique et la fourniture de services consultatifs pour la mise en œuvre d'initiatives basées sur les données probantes.

ChocoSol Horizontal Traders and Chocolatiers www.chocosoltraders.com

#807

ChocoSol’s artisanal dark chocolate is made in Toronto using organic, forest garden cacao, sourced directly from Indigenous communities in Southern Mexico. Our chocolates are made without dairy, gluten, soy, and nuts, and are vegan. We specialize in eating chocolate and drinking chocolate (xocolatl) and offer fresh corn tacos seasonally.

CannTrust Inc. received its license to distribute medical cannabis in February 2015 and is currently offering hydroponically grown pharmaceutical-grade cannabis. The only pharmacist-controlled and pharmacist-operated licensed producer and distributor of medical cannabis in Canada. Committed to producing the highest quality pharmaceutical-grade medical cannabis; promoting evidence-based clinical research; and providing exceptional customer support.

Le chocolat noir artisanal ChocoSol est fabriqué à Toronto à partir de cacao biologique, cultivé en forêt et provenant directement de communautés indigènes du sud du Mexique. Nos chocolats sont végétaliens et ne contiennent pas de produits laitiers, de gluten, de soya et de noix. Nous nous spécialisons dans la dégustation et la boisson du chocolat (xocolatl) et offrons des tacos au mais frais sur une base saisonnière.

CannTrust Inc. est homologuée pour la distribution du cannabis médicinal depuis février 2015. L’entreprise offre du cannabis médicinal de qualité pharmaceutique provenant de cultures hydroponiques. Nous sommes le seul producteur de cannabis médicinal détenu et exploité par des pharmaciens au Canada. Nous nous engageons à produire du cannabis médicinal de la plus haute qualité pharmaceutique, à promouvoir des recherches basées sur des données probantes et à fournir un soutien à la clientèle exceptionel.

Choosing Wisely Canada (CWC) is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments, and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care.

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Choosing Wisely Canada www.choosingwiselycanada.org

#628

Choisir avec soin est une campagne qui vise à aider les médecins et les patients à engager un dialogue au sujet des examens, des traitements et des interventions qui ne sont pas nécessaires. De plus, elle vise à soutenir les médecins de manière à ce qu’ils aident leurs patients à faire des choix judicieux et efficaces en vue d’assurer des soins de qualité.

@familymedforum

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EXHIBITS | EXPOSITION Church & Dwight Canada www.churchdwight.ca

#436

Contest Contribution: Gift basket with products For over 150 years Church & Dwight Canada Corp. has offered trusted solutions for the everyday needs of Canadians. Church & Dwight is a leader in OTC health care, family planning, and personal care, with brands including Gravol, Trojan, Rub•A535, First Response®, Orajel, Arm & Hammer, and many others.

Church & Dwight Canada Corp offre des solutions fiables pour répondre aux besoins quotidiens des Canadiens depuis 150 ans. Chef de file de soins de santé, nous proposons des produits de planification familiale et de soins personnels en vente libre. Nous offrons les marques telles que Gravol, Trojan, Rub•A535, First Response®, Orajel, Arm & Hammer et bien d'autres.

City of Thunder Bay www.thunderbayhealth.ca

#713

Thunder Bay offers a balance of a dynamic work environment and vibrant community in which you can take a leading role. New state-of-the-art facilities incorporating technological advancements are complemented by existing health and community services. Stop by to learn about full-time and locum family physician opportunities!

La ville de Thunder Bay offre un environnement de travail et une communauté dynamiques où il est possible de jouer un rôle de premier plan.

En plus de nos services de santé à la communauté existants, nous offrons de nouvelles installations à la fine pointe, qui comprennent des avancements technologiques. Venez nous voir pour en apprendre davantage sur les occasions de suppléance et les postes à temps plein pour les médecins de famille.

CMA/MD Financial Management www.md.cma.ca

#503 Contest Contribution: iPad Air

Owned by the Canadian Medical Association, MD Financial Management has an unrivaled understanding of the financial needs of Canadian physicians. MD uses this unique insight to deliver unbiased advice and solutions, and help doctors achieve their personal and professional financial goals.

Propriété de l’Association médicale canadienne, Gestion financière MD comprend mieux que quiconque les besoins financiers des médecins canadiens. Cet atout incontestable permet à MD d’offrir des solutions et des conseils objectifs afin d’aider les médecins à atteindre leurs objectifs financiers personnels et professionnels.

College of Physicians and Surgeons of Ontario Assessor Recruitment www.cpso.on.ca

#147

The College is looking for physicians interested in a rewarding experience in medical regulation. We are specifically recruiting assessors to provide expert opinions and review physicians’ practices. Assessors help the College deliver on its mandate of responsible, professional, and ethical decision making in the public interest.

Le Collège est à la recherche de médecins qui souhaitent faire une expérience enrichissante dans le domaine de la réglementation médicale. Nous cherchons particulièrement des évaluateurs pour fournir des opinions d’expert et revoir les pratiques des médecins. Les évaluateurs aident le Collège à réaliser son mandat, à savoir la prise de décisions éthiques, responsables et professionelles dans l'intérêt du public.

Communimed www.communimed.com

#822

Your Doctor and You est un programme d'éducation pour les patients conçu pour les salles d'attente des médecins en soins primaires. Le contenu de ce programme sous forme d'affiche s'appuie sur des données probantes cliniques qui ont été prouvées comme étant efficaces afin de motiver les patients à prendre des mesures pour améliorer leur santé.

Consult Conduit www.consultconduit.com

#M26

Consult Conduit is a Web-based e-consultation service that provides physicians with an interface like “Whatsapp” that emphasizes intraprofessional communication. It reduces the administrative burden of e-consults through in-app billing, while maintaining PHIPPA compliance.

We encourage all physicians who are interested in learning more about e-consultations to visit our booth.

Consult Conduit est un service de consultation sur le Web qui fournit aux médecins un moyen de communication entre professionnels grâce à une interface de type « Whatsapp ». Elle réduit le fardeau administratif lié aux e-consults au moyen de la facturation In-App tout en respectant la Loi sur la protection des renseignements personnels sur la santé. Si vous désirez en savoir davantage au sujet des e-consultations, venez visiter notre kiosque.

ConsultLoop www.consultloop.com

#M28

ConsultLoop is an online booking platform for patient referrals between family doctors and specialists. ConsultLoop tracks referrals from start to finish, offers a broader network of specialists to your patients, and reduces your clinic’s administrative burden. We are actively recruiting family doctors and clinics to participate in our growing network.

ConsultLoop est un système informatisé de réservation en ligne qui facilite les références des patients entre omnipraticiens et spécialistes. ConsultLoop fait le suivi des patients référés du début du processus, et ce, jusqu’à la fin, il offre un vaste réseau de spécialistes à vos patients et réduit le fardeau administratif de votre clinique. Nous recrutons activement des omnipraticiens et des cliniques pour participer à notre réseau en pleine croissance.

Crowe Soberman, Healthcare Group www.crowesoberman.com

#M17 Contest Contribution: Cash

Just as you attend to your patients’ needs, Crowe Soberman’s Healthcare Group looks after you.

Whether you’re beginning your career or considering what’s next, visit our booth to request your financial checkup, and we’ll give you our prescription to maximize capital, minimize taxes, and enhance your financial health.

Tout comme vous prenez soin de vos patients, Healthcare Group de Crowe Soberman prend bien soin de vous. Que vous soyez en début de carrière ou que vous désiriez passer à une nouvelle étape, visitez notre kiosque pour demander un examen financier; nous vous remettrons notre ordonnance afin de maximiser votre capital, de minimiser vos taxes et impôts et d’améliorer votre santé financière.

CTFPHC www.canadiantaskforce.ca

#544

The Canadian Task Force on Preventive Health Care is a national expert panel that develops evidence-based clinical practice guidelines to deliver preventive health care in primary care settings. Visit us for information and resources on guidelines that you can incorporate into your practice and provide input on future guideline topics.

Le Groupe d’Étude Canadien sur les Soins de Santé Préventifs est un groupe national d’experts qui élabore des recommandations de pratique cliniques basées sur des données probantes pour offrir des soins de santé préventifs en soins primaires. Venez nous voir pour obtenir de l’information et des ressources sur les recommandations que vous pourrez intégrer à votre pratique et pour nous donner vos idées sur de futures recommandations.

Your Doctor and You is a patient education program designed for the waiting rooms of primary care physicians. The content of this poster format program is guided by clinical evidence and approaches that are proven effective in motivating patients to take steps toward improving their health.

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EXHIBITS | EXPOSITION Dairy Farmers of Canada www.dairynutrition.ca/www.savoirlaitier.ca

#711

Dairy Farmers of Canada is a non-profit organization representing dairy producers across the country. Visit our booth to talk with our registered dietitians and to get copies of our numerous nutrition and health resources.

Les Producteur laitiers du Canada est un organisme à but non lucratif représentant les producteurs de lait du pays. Visitez notre kiosque pour discuter avec nos diététistes professionnels et obtenir des exemplaires de nos nombreuses ressources sur la nutrition et la santé.

Dalhousie Family Medicine www.family.medicine.dal.ca

#446

Learn more about Dalhousie Family Medicine. Our family medicine residency teaching sites are located throughout the three Maritime provinces—New Brunswick, Nova Scotia, and Prince Edward Island. We also have a three-year integrated FM Emergency Medicine program based in Saint John, NB, and offer many third-year programs. Dalhousie Family Medicine is inspiring minds and impacting communities!

Renseignez-vous sur la médecine de famille à Dalhousie. Nos unités de résidence en médecine familiale sont réparties dans les trois provinces maritimes – Nouveau-Brunswick, Nouvelle-Écosse, et Île-du-Prince-Édouard.

Nous offrons aussi un programme intégré de trois ans en médecine familiale d’urgence à Saint John, au N.-B., ainsi que de nombreux programmes de troisième année. La médecine familiale à Dalhousie est une source d’inspiration qui touche les collectivités!

Ddrops Company www.ddropscompany.com

#317 Contest Contribution: Cash

Ddrops® Company is pleased to assist health care professionals by making it easier for them to educate and better manage their patients’ vitamin D status. Ddrops® are a stress-free way for your patients to get the recommended amount of vitamin D daily in a simple and easy Just One Drop format.

L’entreprise Ddrops® est heureuse d'aider les professionels de la santé en facilitant l'éducation et la prise en charge de la carence en vitamine D de leurs patients. Ddrops est une façon simple pour vos patients d’obtenir la dose quotidienne de vitamine D recommandée, en une seule goutte.

Delta Division of Family Practice www.divisionsbc.ca/delta

#728

Our members work to improve patient access to primary care, increase physicians’ influence on health care delivery and policy, and provide professional support for physicians within our communities of Tsawassen and Ladner. Currently we have full-time, part-time, and locum openings with our supportive, collaborative, collegial family practice communities.

Nos membres s'efforcent à améliorer l'accès des patients aux soins primaires, à augmenter l'influence des médecins dans les domaines de la prestation et de la politique des soins de santé et à fournir un soutien professionnel aux médecins qui exercent dans nos communautés de Tsawassen et de Ladner. Nous offrons des opportunités à temps plein, à temps partiel et de suppléance au sein de nos communautés de pratique de médecine familiale collaboratives et collégiales.

Diva International Inc. www.divacup.com

#529 Contest Contribution: iPad mini 2 prize pack

Diva International Inc. empowers women with a better period care option through education and product awareness. Our product, The DivaCup, offers women of all ages 12 hours of leak-free protection, is comfortable, and saves money! Visit our booth to receive your FREE Resource Kit!

Divigel www.tevacanadainnovation.com

Teva Canada Innovation is committed to providing Canadians with medicines that will improve their lives. We leverage our large-scale operations, scientific resources, and global leadership to develop and produce medicines that are tailored to address patients’ needs.

Teva Canada Innovation s’engage à offrir aux Canadiens des médicaments dans le but d’améliorer leur qualité de vie. Nous tirons parti de notre exploitation à grande échelle, de nos ressources scientifiques et de notre position de chef de file mondial pour mettre au point et produire des médicaments adaptés aux besoins des patients.

Dryden Regional Health Centre www.docjobs.ca

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#M11

The DRHC/Dingwall Medical Group provides a fully modern work environment with a nice mix of experienced physicians and growing complement of newer graduates. Dryden is a clerkship site for the Northern Ontario School of Medicine and teaching opportunities are available at your discretion. Could Dryden be for you?

Le Groupe Médical DRHC/Dingwall vous offre un environnement de travail moderne où collaborent des médecins chevronnés et un nombre croissant de nouveaux diplômés. Dryden est un site d'externat pour l'École de médecine du Nord de l'Ontario et des opportunités d'enseignement vous sont disponibles. Dryden serait-il l’endroit pour vous?

Eczema Society of Canada / Société canadienne de l’eczéma www.eczemahelp.ca

#646

We are a national registered charity dedicated to providing patient support, education, awareness, and research. Visit our booth to obtain free patient resources, including treatment guides, bathing and moisturizing information, and eczema assessments. We are here to help you help your eczema patients!

Nous sommes un organisme national de bienfaisance enregistré qui se consacre au soutien des patients, à l'éducation, à la sensibilisation et à la recherche. Visitez notre kiosque pour obtenir des ressources gratuites pour le patient, y compris des guides de traitement de l'information concernant le bain, l'hydratation ainsi que l'évaluation de l'eczéma. Nous sommes ici pour vous aider à aider vos patients qui souffrent d’eczéma!

Egg Farmers of Canada www.eggs.ca

#203

Visit us at the Egg Farmers of Canada booth to break the myth about eggs and cholesterol!

Visitez le kiosque des Producteurs d’œufs du Canada pour faire toute la lumière sur le mythe entourant les œufs et le cholestérol!

Exercise is Medicine Canada www.exerciseismedicine.ca

#326

Contest Contribution: Clinic Pedometer Loaner Kits The evidence is undeniable: Exercise is powerful medicine! Let EIMC help you help your patients achieve the physical activity guidelines. Learn about the compelling evidence behind the guidelines. Access our evidence-based tools and resources that help you prescribe the right dose, intensity, and frequency easily and confidently in your clinic.

Les faits le prouvent — l'exercice est un puissant médicament! Avec l'aide de l'EMC, vous serez en mesure d'aider vos patients à atteindre les normes recommandées en matière d'activité physique. Renseignez-vous sur les données probantes sur lesquelles ces normes sont basées. Accédez à nos outils et à nos ressources axés sur les données probantes afin de prescrire la dose, l'intensité et la fréquence appropriées à vos patients avec confiance.

Diva International Inc propose aux femmes une meilleure protection hygiénique par l’intermédiaire de l'éducation et de la connaissance des produits. DivaCup offre aux femmes de tous âges une protection de douze heures confortable, économique et sans fuite. Visitez notre kiosque et recevez une trousse GRATUITE!

fmf.cfpc.ca

#706

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EXHIBITS | EXPOSITION Fraser Northwest Division of Family Practice www.divisionsbc.ca/frasernw

#546

Government of Nunavut, Department of Health www.nunavut-physicians.gov.nu.ca

#312

Chilliwack and the Fraser Northwest represent over 300 family physicians in both rural and urban settings in the lovely Fraser Valley and close to Vancouver. We have many opportunities for you and your family—come see and hear more about living and practising family medicine in this beautiful area of BC!

Welcome to Nunavut. This is a truly unique opportunity to experience rich Inuit culture, breathtaking scenery, and a change of pace. Family physicians, locums or full-time, with obstetrical skills, emergency experience, a sense of adventure, and a desire to make a real difference in our 25 communities, are needed.

Chilliwack et le Fraser Northwest, qui se trouvent dans la charmante vallée du Fraser, près de Vancouver, représentent plus de 300 médecins de famille en milieux ruraux ou urbains. Nous avons de nombreuses occasions pour vous et votre famille. Venez nous visiter afin d'en apprendre davantage sur la vie at la pratique de la médecine familiale dans cette région magnifique de la Colombie Britannique.

Bienvenue au Nunavut, où vous trouverez une possibilité unique de faire l’expérience de la riche culture inuite et de profiter de paysages époustouflants et d’un changement de rythme de vie. Nous avons besoin de médecins de famille, à titre de remplaçants ou de médecins à temps plein, compétents en obstétrique et en médecine d’urgence, qui ont le goût de l’aventure et le désir de faire une réelle différence dans nos 25 collectivités

Galderma Canada www.galderma.ca

#633

Galderma Canada is an innovation-based dermatology company focused on delivering effective dermatological solutions to the medical community and their patients. As a global leader in acne, Galderma has taken assertive action to remove and discontinue all topical erythromycin- and clindamycincontaining acne products from its global portfolio. Antibiotic resistance is a growing concern.

Galderma Canada est une entreprise de dermatologie axée sur l’innovation, qui offre des solutions dermatologiques efficaces à la communauté médicale et à ses patients. Chef de file mondial dans le traitement de l'acné, Galderma a pris des mesures décisives pour éliminer et discontinuer tous les produits pour le traitement de l'acné contenant l'érythromycine topique et le clindomycine de son portefeuille mondial. La résistance aux antibiotiques est une préoccupation croissante.

General Practice Psychotherapy Association www.gppaonline.ca

#724

The General Practice Psychotherapy Association (GPPA) is devoted to helping members achieve expertise in medical psychotherapy. A comprehensive education program provides credits that can be used, for example, to maintain licensure in Ontario (CPS0). At our booth a video is available summarizing other key details of member benefits.

La General Practice Psychotherapy Association (GPPA) a pour but d’aider ses membres à acquérir de l’expertise dans le domaine de la psychothérapie médicale. Son programme d'enseignement complet donne droit à des crédits qui peuvent, par exemple, servir à maintenir le permis d'exercice en Ontario (CPS0). À notre kiosque, vous pourrez visionner une vidéo qui résume d'autres importants avantages offerts aux membres.

Global Medical Staffing www.gmedical.com

#323

We offer extraordinary opportunities that last from a few days, to a month, to a year or longer in locations around the globe. We handle all the details and you get a new perspective on life—and medicine. The world is your practice—where do you want to go?

Nous offrons des occasions extraordinaires d'une durée de quelques jours, d’un mois, d’un an ou plus partout au monde. Nous nous occupons de tous les détails et vous bénéficiez d’une nouvelle perspective sur la vie et la médecine. Vous pouvez pratiquer n'importe où; où désirez-vous aller?

Global Medics www.globalmedics.com

#M23

GSK www.gsk.ca

#830

GSK will be exhibiting products from our respiratory portfolio indicated for asthma or COPD, such as Breo, Anoro, and Advair.

GSK présentera sa gamme de produits respiratoires recommandés pour l'asthme ou le MPOC tels que Breo, Anoro et Advair.

Hastings County www.hastingsdoctors.com

Hastings County, located 1.5 hours east of Toronto, has a Family Physician Recruitment Program that supports students at a Canadian medical school or residency, or recent graduates, by paying $25,000/year for 6 years, for a 5-year return-of-service agreement to practise family medicine in one of our 14 member municipalities.

Le comté de Hastings, situé à une heure et demi à l'est de Toronto, offre un programme de recrutement de médecins de famille destiné aux étudiants en médecine, aux résidents ou aux nouveaux diplômés d’une faculté de médecine canadienne. Nous offrons une rémunération de 25 000 $ par année pendant six ans en contrepartie d’une entente de retour de services de cinq ans pour l’exercice de la médecine familiale dans l’une de nos 14 municipalités membres.

Health Match BC www.healthmatchbc.org

Contest Contribution: Cash

Health Match BC est un service gratuit de recrutement de professionnels de la santé financé par le gouvernement de la ColombieBritannique. Notre équipe de services aux médecins jumelle des médecins de famille qualifiés à des possibilités de carrière qui correspondent à leur style de vie et leurs intérêts. Si vous êtes médecin de famille et que vous cherchez de l’emploi en Colombie-Britannique, communiquez avec Health Match BC dès aujourd’hui.

Health Partners International of Canada www.hpicanada.ca

#744

Contest Contribution: Physician Travel Pack HPIC’s Physician Travel Pack. Find out how you can obtain an assortment of essential medicines for your next medical mission.

La Trousse médicale humanitaire de HPIC. Découvrez comment obtenir un assortiment de médicaments essentiels pour votre prochaine mission humanitaire.

Global Medics, l’un des plus grands spécialistes du recrutement médical au monde, réunit médecins et employeurs depuis 2001. Avec des bureaux au Canada, au Royaume-Uni, en Irlande, en Australie et en Nouvelle-Zélande, ainsi que d'autres consultants sur le terrain, nous aidons les médecins à trouver l’occasion de carrière parfaite et les cliniques à retenir des médecins de classe mondiale. Nous rendons le processus aussi simple et efficace que possible pour tous.

familymedicineforum

#531

Health Match BC is a free health professional recruitment service funded by the Government of British Columbia (BC), Canada. Our physician services team matches qualified family physicians to opportunities that suit their career and lifestyle interests. If you are a family doctor seeking employment in BC, contact Health Match BC today.

Global Medics is one of the world’s leading medical recruitment specialists and has been bringing physicians and employers together since 2001. With offices in Canada, UK, Ireland, Australia, and New Zealand and locally based consultants, we help physicians to find the perfect opportunity, and clinics to secure world-class physicians, making the process as simple and efficient as possible for everyone involved.

fmf.cfpc.ca

#329

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EXHIBITS | EXPOSITION Health Quality Ontario www.hqontario.ca

#610

Health Quality Ontario (HQO) is the provincial advisor on health care quality. HQO reports on the quality of the health care system, evaluates the effectiveness of new health care technologies and services, provides evidence-based recommendations, and supports the spread of quality improvement activities. Visit http://www.hqontario.ca/ for more information.

Qualité des services de santé Ontario (QSSO) conseille la province au sujet de la qualité des soins de santé. QSSO rend des comptes sur la qualité du système de santé, évalue l’efficacité des nouveaux services et technologies de la santé, formule des recommandations fondées sur des données probantes et appuie la diffusion des activités visant à améliorer la qualité. Rendez-vous à http://www.hqontario.ca/accueil

Hofstetter Business Technologies www.hofstetter.com

#616

Hofstetter Business Technologies will offer delegates information on the latest technology advancements for medical professionals, in the area of dictation and speech recognition. You will see the latest in speech recognition from Dragon Medical and the latest in cloud-based dictation solutions. Working displays and “hands-on testing” of these latest offerings from Philips, Dragon, & Nuance is possible. Consultants will be on hand to discuss questions regarding customized implementations for medical practices.

Hofstetter Business Technologies offrira aux délégués des renseignements sur les dernières avancées technologiques dans le domaine de la dictée et la reconnaissance vocale pour les professionels médicaux. Vous verrez les technologies les plus récentes de reconnaissance vocale de Dragon Medical ainsi que des solutions de dictée axées sur l'informatique en nuage. Vous pourrez consulter des affiches et faire l’essai des derniers produits signés Philips, Dragon et Nuance. Nos consultants seront sur place pour répondre à toutes vos questions sur la mise en œuvre personalisée dans les pratiques médicales.

Homewood Health Centre www.homewoodhealth.com/health-centre

Homewood Health est le chef de file canadien des services en santé mentale et de dépendance. Notre gamme complète de services vise le mieux-être organisationnel, les programmes d'aide, les évaluations médicales, les traitements en milieu hospitalier ou ambulatoires, la gestion du rétablissement des patients et les services de réintégration au travail. Ces services sont personalisés afin de répondre aux besoins particuliers des individus et des organisations. Homewood Health redéfinit le traitement des troubles de santé mentale et de dépendance afin d'aider les Canadiens à vivre une vie plus saine, plus productive et plus riche.

#110 Contest Contribution: Cash

Hypertension Canada is a non-profit, charitable organization, advancing health through the prevention and control of high blood pressure and its complications. Our vision, shared with many partners in the health field, is that Canadians will have the healthiest and best-managed blood pressure in the world.

Hypertension Canada est une association caritative sans but lucratif qui a pour but de promouvoir la santé par la prévention et la maîtrise de l'hypertension artérielle et de ses complications. Notre vision, partagée avec de nombreux partenaires du domaine de la santé, est de faire en sorte que les Canadiens et les Canadiennes aient une saine pression artérielle et le meilleur contrôle au monde.

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The i-GAP booth at FMF will increase knowledge and understanding of Advance Care Planning (ACP), share the results of the patient and health care provider ACP audit, and present findings from the ACP tool testing and evaluation in primary care practices across Ontario, Alberta, and British Columbia.

Le kiosque i-GAP, au FMF, fera augmenter la connaissance et la compréhension de la planification préalable des soins (PPS), diffusera les résultats de la vérification PPS des patients et des fournisseurs de soins et présentera les conclusions de la mise à l’essai des outils et de l’évaluaiton menée dans les pratiques de soins primaires en Ontario, en Alberta, et en Colombie-Britannique.

Imagine Health Centres www.imaginehealthcentres.ca

#509

Imagine Health Centres is a leader in primary health care innovation and collaborative multidisciplinary medical services with high-profile sites across Alberta. Our focus is on quality patient care and preventive medicine. We offer our physicians attractive practice options, lucrative opportunities, superior administrative support, and a team atmosphere.

Imagine Health Centres est un chef de file de l’innovation dans le domaine des soins primaires et des services médicaux multidisciplinaires et collaboratifs. Nos sites sont bien connus partout en Alberta. Notre principale préoccupation consiste à fournir aux patients des soins de haute qualité et la médicine préventive. Nous offrons à nos médecins des options de pratique attrayantes et lucratives, un soutien administratif supérieur et une ambiance d'équipe.

Indivior Canada Ltd. www.indivior.com

#205

Homewood Health is Canada’s leader in mental health and addiction services. Our complete continuum of services includes organizational wellness, assistance programs, assessments, outpatient and inpatient treatment, recovery management, return to work, and family support services, customized to meet the specialized needs of individuals and organizations.

Homewood Health is redefining mental health and addiction services to help Canadians live healthier, more productive, and more fulfilling lives.

Hypertension Canada www.hypertension.ca

i-GAP – Improving Advance Care Planning in General Practice www.thecarenet.ca

#331 Contest Contribution: Gift card—The Keg

Indivior Canada Ltd. is at the forefront providing educational resources and treatment options to physicians and patients dealing with the chronic relapsing disease of opioid dependence. Please visit their exhibit where Indivior clinical liaisons will be available to discuss the indications, provide scientific information, and answer your questions about a unique treatment option.

Indivior Canada Ltd. est à l’avant-garde des ressources éducatives et des options de traitement destinées aux médecins et aux patients aux prises avec la dépendance aux opioïdes, maladie chronique récidivante. Visitez notre stand où nos agents de liaison clinique se tiendront à votre disposition pour discuter des indications de cette option de traitement unique, vous fournir des informations scientifiques et répondre à vos questions à cet égard.

Infinite Trading www.hidow.com

#M25

TENS (Transcutaneous Electrical Nerve Stimulation) is a medical device using electrical currents to relieve pain and provide other therapeutic benefits. A gentle electrical current is passed through electrodes attached to the skin near the site of the pain or discomfort. The pulses send bio-electrical signals through the central nervous system blocking pain receptors in the same way a strong painkiller would.

Le ENS (une neurostimulation électrique transcutanée) est un appareil médical qui émet un courant électrique afin de soulager la douleur et d'apporter d'autres bienfaits thérapeutiques. Le courant électrique de faible tension est transmis par des électrodes placées sur la peau près du site de la douleur ou de l'inconfort. Ces courants envoient des signaux bioélectriques au système nerveux central et bloquent les récepteurs de la douleur tout comme un analgésique puissant le ferait.

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EXHIBITS | EXPOSITION innoviCares www.innovicares.ca

#533

Janssen Inc. www.janssen.ca

#517

InnoviCares is Canada’s largest free supplementary benefit plan, providing nearly a million Canadians with coverage on brand-name medications and savings on medical products. By bridging the cost difference between brandname medications and their generic alternatives, innoviCares supports greater access and choice, and improves patient adherence to medications.

At Janssen, we are dedicated to addressing and solving some of the most important unmet medical needs in oncology, immunology, neuroscience, infectious diseases and vaccines, metabolic and chronic diseases, and women’s health. Driven by our commitment to patients, we bring innovative products, services, and solutions to people throughout the world.

InnoviCares est le plus important régime d’avantages complémentaires gratuits. Il offre une couverture des médicaments de marque et des économies sur des produits médicaux à près d’un million de Canadiens et de Canadiennes. En comblant la différence de coûts entre les médicaments de marque et leur choix de rechange générique, innoviCares favorise un meilleur accès et plus de choix, ce qui améliore le respect de la pharmacothérapie.

Janssen Inc. s’emploie à répondre aux plus importants besoins médicaux non pris en compte dans les domaines de l’oncologie, de l’immunologie, de la neuroscience, des maladies infectieuses, des vaccins, des maladies métaboliques et chroniques et de la santé de femme. Motivés par notre engagement envers les patients, nous offrons des solutions, produits et services novateurs dans le monde entier.

Interior Health Authority – BC www.betterhere.ca

#725

FPs in Interior Health provide services to 749,600 residents in BC’s sunny Southern Interior. Opportunities are available for FP’s interested in clinic practice as well as those with emergency, anesthesia, obstetrics and surgery training. Urban and rural locations offer exceptional lifestyle and recreation.

Les médecins de famille de la régie de la santé du Centre de la C.-B. offrent des services à 749 600 résidants de cette région intérieure du sud de la province. Des possibilités sont offertes aux MF intéressés à une pratique en clinique ainsi qu’à ceux qui ont une formation en anesthésie, en médecine d’urgence, en obstétrique et en chirurgie. Des emplacements urbains et ruraux offrent des choix exceptionnels de modes de vie et de loisirs.

Island Health www.viha.ca

#542 Contest Contribution: Cash

Island Health provides health care services to the 752,000 residents of Vancouver Island. A variety of urban and rural family physician opportunities and practice models are available. Visit our booth to meet our recruitment team and family physicians, or email us at physicians@viha.ca to discover Island Life—with unlimited possibilities for your career, family, and future!

Island Health fournit des services de santé aux 752 000 résidents de l'île de Vancouver. Il offre diverses occasions de carrière et des modèles de pratique aux médecins de famille en milieu urbain ou rural. Visitez notre kiosque pour découvrir toutes les possibilités qui s’offrent à vous et à votre famille que l'île de Vancouver peut offrir et rencontrer notre équipe de recruteurs et de médecins de famille, ou communiquez avec nous par courriel à physicians@ viha.ca.

IUD Insertion Training

#727

Dr Ellen Wiebe and Dr Konia Trouton are family doctors who run IUD clinics and will be available to teach IUD insertions in the exhibit hall Thursday 9-5, Friday 9-4, and Saturday 9-1. They will have the various IUDs that are available in Canada and will use models and slides for teaching in English and French.

Les Drs Ellen Wiebe et Konia Trouton dirigeront l'atelier de pose de stérilet dans le Hall d'exposition le jeudi de 9 h à 17 h, le vendredi de 9 h à 16 h et le samedi de 9 h à 13 h. Elles mettront à la disposition des participantes tous les types de stérilets disponibles au Canada et utiliseront des modèles ainsi que des diapositives lors de l'enseignement (en anglais et en français).

Jack Nathan Health www.jacknathanhealth.com

Kapuskasing & District Recruitment www.kapuskasing.ca; www.senhosp.ca

#M21

Kapuskasing & District Recruitment Committee is looking for permanent family physicians, GP/anesthetist, as well as a psychiatrist. We are also looking for locums to work in the Emergency Department as well as locum hospitalists. For more information please contact Nicole Hachez at nhachez@ senhosp.ca or visit me at my booth.

Le comité de recrutement de Kapuskasing et des environs est à la recherche de médecins de famille, d’omnipraticiens/anesthésistes ainsi que d’un psychiatre pour des postes permanents, ainsi que de médecins suppléants pour le service des urgences et en hôpital. Pour de plus amples renseignements, veuillez communiquer avec Nicole Hachez à nhachez@ senhosp.ca ou visitez-nous à notre kiosque.

Kincardine & Saugeen Shores Recruitment www.physicianquest.ca

#M4

Physicians are not strangers to hard work but what about life balance that everyone is talking about? The beautiful Lake Huron coastal communities of Southampton, Port Elgin, and Kincardine have partnered to attract family physicians and Emergency Room physicians. Access to health care is essential to a vibrant local community. Join us and let the adventure begin—contact PhysicianQuest.

Les médecins ont l’habitude de travailler fort, mais trouver l'équilibre entre le travail et la vie personnelle présente souvent un défi. Comment l'atteindre?

Les magnifiques municipalités de Southampton, Port Elgin et Kincardine qui longent le lac Huron se sont réunies pour attirer des médecins de famille et des urgentologues. L'accès aux soins de santé est essentiel dans une communauté dynamique. Partons à l'aventure – contactez Physician Quest.

Kirkland and District Hospital www.kdhospital.com

#M13

Tired of the commute? Come and experience a terrific multidisciplinary medical practice setting and live on the lake 10 minutes from the hospital!

Attractive incentives, low turnkey overhead ($2,000/month), hospitalist program, family health team, friendly community! Take a walk on the LIFE side … check out what Kirkland Lake has to offer!

Fatigués de la circulation? Venez faire l'expérience d'une pratique médicale multidisciplinaire et dynamique, au bord du lac, à une dizaine de minutes seulement de l'hôpital! Des mesures incitatives attirantes, des frais généraux faibles (2 000 $/mois), un programme hospitalier, une équipe de médecine familiale et une communauté accueillante vous attendent! Venez voir tout ce que Kirkland Lake a à vous offrir!

#423

Jack Nathan Health is committed to improving access to public health care by delivering consistent, quality care in state-of-the-art medical clinics across Canada. We are proud to partner with Walmart Canada to deliver quality health care services and convenience to its customers, while providing doctors with turn key opportunities and services.

Jack Nathan Health s'engage à améliorer l'accès aux soins de santé publique en fournissant de manière constante des soins de qualité dans des cliniques médicales hors pairs à travers le Canada. Nous sommes fiers de nous associer à Walmart Canada afin de fournir à ses clients la commodité et des soins de santé de qualité, ainsi que des opportunités et des services clé en main aux médecins.

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EXHIBITS | EXPOSITION LifeLabs www.lifelabsgenetics.com; www.lifelabs.com

#643

Contest Contribution: Cash LifeLabs is a Canadian-owned company with over 50 years of experience providing laboratory testing services to help health care providers diagnose, treat, monitor and prevent disease in patients. Across British Columbia and Ontario, LifeLabs delivers cost-effective, convenient access to laboratory testing services essential for optimal outcomes in health care. LifeLabs performs over 100 million laboratory tests, supporting over 19 million patient visits annually.

LifeLabs, une entreprise canadienne avec plus de 50 années d'expérience, fournit aux professionnels de la santé des services de tests de laboratoire afin de les aider à diagnostiquer, à traiter, à contrôler et à prévenir les maladies des patients. Partout en Colombie-Britannique et en Ontario, LifeLabs offre un accès économique et pratique aux tests de laboratoire, ce qui contribue à des résultats optimaux dans la prestation des soins. Chaque année, LifeLabs effectue plus de 100 millions de tests de laboratoire, appuyant plus de 19 millions de visites de patients.

ListenUP Canada www.listenupcanada.com

#212

ListenUP! Canada is the largest hearing health care provider in Ontario with more than 100 locations across the province. All of their hearing centres offer free, no-obligation hearing tests by certified hearing professionals and the latest brand-name, digital hearing aids and assistive listening devices for affordable prices.

Les programmes en ligne machealth de l'Université de McMaster vous offrent le meilleure apprentissage en ligne ainsi qu’un accès gratuit à des cours agréés de FMC et DPC axés sur les données probantes, des ressources destinées aux patients et des forums communautaires pour vous et vos pairs.

Accédez à des cours sur des sujets variés, dont le radon, l'ostéoporose et les troubles de l'acquisition de la coordination.

Malpractice Check www.malpracticecheck.com

Malpractice Check™ assesses the merits of patients’ malpractice concerns following treatment by specialists. Our physician-led Canadian company provides neutral evidence-based opinions from board-certified MDs directly to patients, avoiding ethical dilemmas for FPs. The two-step confidential Web-based service inexpensively evaluates the Standard of Care prior to considering costly legal options.

Malpractice Check™ évalue le bien-fondé des craintes de poursuite pour faute professionnelle médicale suivant le traitement d'un spécialiste. Notre entreprise canadienne dirigée par des médecins fournit des opinions neutres fondées sur des preuves émises par des médecins compétents directement aux patients, évitant ainsi des dilemmes éthiques pour les médecins de famille.

Ce service en ligne en deux étapes, confidentiel et peu coûteux évalue les normes médicales avant de considérer des options juridiques plus coûteuses.

Manitoba’s Office of Rural and Northern Health & Manitoba Health www.ornh.mb.ca

Notre approche de l’innovation a été façonnée par nos origines danoises, tradition vieille de plusieurs sciècles qui respecte l’individu et nous pousse à prendre soin de ceux qui sont dans le besoin. Nous croyons à l’importance de créer des partenariats, de travailler en collaboration avec des professionnels de la santé et de faire passer l’intérêt des patients avant tout; et nous continuerons sur cette voie tout en déployant nos activités sur l’oncologie.

M and M Sales – “Human Touch Dealer” www.mandmsales.ca

#Lounge 4

At Human Touch we have designed the perfect massage chair for staff, patient, and home wellness. We have now been able to replicate real human hands of a massage therapist and put the technology in gorgeous recliner chairs suitable for any business or home. Sit down, relax, and feel the difference.

Human Touch a créé le fauteuil de massage parfait pour le personnel, les patients et pour usage à la maison. Nous avons réussi à reproduire la touche humaine d'un massothérapeute dans nos fauteuils inclinants somptueux. Ils sont appropriés pour l'usage commercial ou à domicile. Venez vous asseoir, relaxez et ressentez la différence.

Machealth www.machealth.ca

#M12

Get the best evidence-based, e-learning experience from McMaster University’s machealth online programs, and access free, accredited CME and CPD courses, patient resources, and community forums for you and your peers. Access courses ranging from radon, to osteoporosis, to developmental coordination disorders.

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Connecting you to health care education and employment opportunities in rural and northern Manitoba.

Nous portons à votre attention des occasions d'emploi et d'éducation en soins de santé dans les régions rurales et du Nord du Manitoba.

#416

Our approach to innovation is shaped by our Danish origins, a centuriesold tradition of respecting every individual and taking care of one another in times of need. Creating partnerships, working with health care professionals, and putting patients first will always be an important part of everything we do, and we will continue to do so as we branch out into oncology.

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#647

Contest Contribution: Cash

ListenUP! Canada est le plus important fournisseur de prothèses auditives en Ontario, avec plus de 100 emplacements dans la province. Tous ses centres de soins de santé auditives offrent des tests auditifs gratuits et sans obligation, effectués par des audioprothésistes professionnels certifiés. Il offre les derniers appareils auditifs numériques et les dispositifs spécialisés facilitant l'écoute de marque, à des prix abordables.

Lundbeck Canada www.lundbeck.ca

#428

ManthaMed Inc. www.manthamed.com

#602

Contest Contribution: Watch BP Office BP Monitor ManthaMed is a medical device distributor of diagnostic and monitoring systems for the management of asthma, COPD, hypertension, dyslipidemia, and diabetes. Products include EasyOne and on-PC spirometers, BpTRU, WatchBP Family of Blood Pressure Technology, A&D TM-2430 24-Hour Ambulatory and LifeSource Blood Pressure Monitors, Cholesterol and A1C Monitoring Systems and Summit Vascular Testing Systems.

ManthaMed Inc est un distributeur d'instruments médicaux qui offre des systèmes de diagnostic et de surveillance pour une meilleure prise en charge de maladies telles que l'asthme, la MCOP, l'hypertension, la dyslipidémie et le diabète. Nos produits incluent les spiromètres EasyOne et on-PC, les tensiomètres BpTru, la technologie Watch BP Family of Blood Pressure, les tensiomètres A&D TM-2430 24 hr Ambulatory et Life Source. Nous offrons également les systèmes de contrôle AIC et pour le cholestérol ainsi que les systèmes de tests Summit Vascular.

McGill University www.mcgill.ca/familymed

#344 Contest Contribution: Cash

The McGill Family Medicine Residency is a fully accredited program.

We will feature information on the reasons why our training program is highly rated by residents year after year. Our booth features helpful handouts and information pamphlets.

Le Programme de résidence en médecine familiale de McGill a reçu un agrément complet. Nous vous informerons des raisons qui poussent les résidents, année après année, à donner une cote élevée à notre programme de résidence. Nous vous présenterons également une description détaillée de notre programme de résidence.

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EXHIBITS | EXPOSITION MCI The Doctor’s Office™ www.mcithedoctorsoffice.ca

#308 Contest Contribution: Cash

MCI Medical Clinics, a division of Altima Healthcare, provides doctors with complete management of clinic operations thus allowing physicians, family practice and walk-in doctors, plus specialists, to focus 100 per cent on patient care. With close to 30 years of experience, MCI manages 27 family medicine clinics with 300 doctors in the Toronto area and Calgary caring for 1,000,000 patients a year.

MCI Medical Clinics, division de Altima Healthcare, offre aux médecins une gestion complète du fonctionnement d’une clinique, ce qui permet aux médecins, aux pratiques de médecine familiale et aux médecins qui travaillent dans les cliniques sans rendez-vous avec spécialistes de se concentrer pleinement sur les soins de leurs patients. Avec près de 30 ans d'éxperience, MCI gère 27 cliniques de médecine familiale dans la région de Toronto et à Calgary dans lesquelles travaillent 300 médecins qui prennent en charge 1 000 000 de patients chaque année.

McMaster University www.fammedmcmaster.ca

#442

McMaster’s Family Medicine Program offers many sites and learning opportunities such as large teaching units and community-based practices; both urban and rural settings; educational opportunities in an interprofessional environment; award-winning faculty; evidence-based medicine; and a behavioural science horizontal curriculum. Our program is flexible and resident-centred. Drop by and see us!

Le programme de médecine familiale de l’Université McMaster offre plusieurs lieux et possibilités d’apprentissage tels que de grandes unités d’enseignement et des pratiques communautaires; des installations urbaines et rurales; des possibilités éducatives dans un environnement interprofessionnel; des professeurs lauréats de prix; la médecine factuelle et un cursus horizontal en sciences comportementales. Notre programme est flexible et centré sur le résident. Venez nous visiter!

MD Agility www.mdagility.com

#623

MD Agility provides clinic medical administration services including call answer, referral and fax management and EMR clinic scheduling. Your clinic’s overall productivity, efficiency, patient care and profitability will increase while expenses and response turnaround time will decrease. Clinics save on physical space, HR hiring and training, and most importantly time.

MD Agility offre des services d'administration aux cliniques médicales, dont la réponse aux appels, les références, la gestion des télécopies et la planification d'horaires cliniques au moyen du DMÉ. L'efficacité, la rentabilité et la productivité de votre clinique augmenteront alors que vos dépenses, le temps de réponse et le délai d'exécution diminueront. Les cliniques utilisent moins d’espace, ne se préoccupent pas de l’embauche et de la formation du personnel et avant tout, elles économisent du temps.

mdBriefCase.com www.mdBriefcase.com

#812 Contest Contribution: iPad mini & cover

mdBriefCase Group Inc. provides free online accredited continuing medical education for Canadian health care professionals. Since 2001, we have worked with key opinion leaders, medical societies, and accrediting bodies to develop programs that help improve and expand our members’ practice. mdBriefCase Group Inc fournit aux professionels de la santé au Canada une formation médicale continue agréée en ligne. Depuis 2001, nous travaillons de concert avec les principaux leaders d'opinion, des associations médicales et des organismes d'agrément afin de créer des programmes qui améliorent et élargissent la pratique de nos membres.

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MD Circles

#M27

MD Circles is a new free mobile application and online platform that facilities the networking of clinicians for the betterment of their patients. It has been created by clinicians for clinicians, aiming to connect doctors across all of Canada. Come by our booth for a free demonstration!

MD Circles est une nouvelle application mobile gratuite et une plateforme électronique qui facilite le réseautage des cliniciens pour le mieux-être de leurs patients. MD Circles a été créé par des cliniciens pour les cliniciens afin de relier des médecins de partout au Canada. Visitez notre kiosque pour une démonstration gratuite!

MDSearch Canada www.mdsearch.ca

#507

MDSearch is a physician recruitment agency based in Toronto, Ontario.

MDSearch est une agence de recrutement des médecins située à Toronto (Ontario).

Medical Council of Canada www.mcc.ca

#145

The Medical Council of Canada strives to achieve the highest level of medical care for Canadians through excellence in evaluation of physicians. It conducts over 12,000 assessments of medical students and graduates every year through its examinations. Its exams are offered in both official languages in sites across Canada, and, in the case of the MCCEE, in over 500 locations in 80 countries.

Le Conseil médical du Canada veille à offrir aux Canadiens et Canadiennes les meilleurs soins médicaux qui soient grâce à l'excellence de l'évaluation des médecins. Il mène chaque année plus de 12 000 évaluations d’étudiants et de diplômés en médecine au moyen de ses examens. Les examens sont administrés dans les deux langues officielles dans des centres d'examen partout au Canada et, dans le cas de l’EECMC, dans plus de 500 centres répartis dans 80 pays.

Medical Futures Inc. www.medfutures.com

#330

Medical Futures Inc. is a niche pharmaceutical company that sells both pharmaceutical and natural therapeutic products into the North American marketplace. Founded in 2000, Medical Futures is privately owned and based in Richmond Hill, Ontario. The staff are dedicated to advancing health care for both Canadians and Americans. Medical Futures actively seeks out and researches new products for introduction into several therapeutic areas including gastroenterology, pain management, dermatology, and women’s health.

Medical Futures Inc est une entreprise de pharmaceutique de créneau qui vend des produits pharmaceutiques et des produits naturels thérapeutiques en Amérique du Nord. Fondée en 2000, Medical Futures est une entreprise privée basée à Richmond Hill (Ontario). Les membres de son personnel se consacrent à l'avancement des soins de santé pour les Canadiens et les Américains. Ils font des recherches et cherchent à inégrer de nouveaux produits dans plusieurs domaines, dont la gastroentérologie, la gestion de la douleur, la dermatologie et la santé des femmes.

Medreleaf Medical Cannabis www.medreleaf.com

#222

MedReleaf is a fully licensed Canadian medical cannabis producer and distributor. We operate from a state-of-the-art, 55,000-square-foot facility in Markham, Ontario, where we produce exclusive medical grade cannabis varieties. Through tireless clinical research and in concert with the Canadian medical community, we are dedicated to leading the way in the discovery of, and education on, its medical and therapeutic benefits. We are setting The Medical Grade Standard™.

MedReleaf est un producteur et distributeur de cannabis à des fins médicales homologué par Santé Canada. Notre site de production de pointe de 55 000 pieds carrés est situé à Markham (Ontario), où nous produisons des variétés de cannabis médicinales exclusives. Au moyen de nombreuses recherches cliniques et de soutien de la communauté médicale au Canada, nous souhaitons assumer le leadership dans la découverte et l'éducation au sujet des bienfaits médicaux et thérapeutiques du cannabis. Nous sommes à l’origine de The Medical Grade Standard™.

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EXHIBITS | EXPOSITION Memorial University of Newfoundland www.med.mun.ca/familymed

#343

If you’re interested in training in rural/remote and urban communities across Newfoundland and Labrador, New Brunswick, and Nunavut, then the Family Medicine Residency Program at Memorial University is for you. Drop by our booth to learn about the unique training opportunities that our program has to offer.

Si vous êtes intéressés à suivre une formation dans les communautés rurales éloignées et urbaines de Terre-Neuve, du Labrador, du Nouveau-Brunswick et du Nunavut, le Programme de résidence en médecine familiale de l’université Memorial est pour vous. Visitez notre kiosque pour en savoir plus sur les possibilités de formation uniques de notre programme.

Mental Health Commission of Canada www.mentalhealthcommission.ca

#M8

Contest Contribution: Cash The Mental Health Commission of Canada (MHCC) was created to improve the mental health system and change attitudes around mental health. Come find out about our many initiatives and projects, including the Mental Health Indicators for Canada and the Opening Minds anti-stigma projects.

La Commission de la santé mentale du Canada a été créée pour améliorer le système de soins en santé mentale et changer les attitudes. Venez découvrir les nombreuses initiatives et projets, notamment les Indicateurs de la santé mentale au Canada et le projet Changer les mentalités contre la stigmatisation.

Mettrum Health Corporation www.mettrum.com

#127

Mettrum Health Corporation is a Health Canada licensed producer and vendor of medical cannabis. Mettrum is committed to helping physicians and their patients responsibly consider medical cannabis as a viable treatment option. Learn how the Mettrum Spectrum™ simplifies medical cannabis treatment decisions for physicians and patients, and discover our new line of Mettrum Originals™ hemp products.

Mettrum Health Corporation est un producteur et distributeur de cannabis médical autorisé par Santé Canada. Son but est d’aider les médecins et leurs patients à considérer le cannabis médical comme une option de traitement viable. Apprenez comment le SpectreMC Mettrum simplifie la prise de décision de traitement par cannabis médical pour les médecins et leurs patients et découvrez notre nouvelle gamme de produits de chanvre Mettrum Originals™.

Methapharm Inc. www.methapharm.com

#609

Contest Contribution: Gift basket—Skincare products Methapharm, a Canadian specialty pharmaceutical company, distributes specialty products like Kelo-cote Silicone Gel and Spray for Scars, Kelo-stretch Stretch Mark Cream, Atopiclair Cream for Symptoms of Atopic Dermatitis and Sebclair Cream for Symptoms of Seborrheic Dermatitis. Our mission is to help bring needed products to practitioners and patients in Canada.

Methapharm est une entreprise pharmaceutique qui distribue des produits spécialisés tels que le gel de silicone Kelo-cote, un vaporisateur contenant une formule avancée pour les cicatrices, la Crème pour les vergetures Kelo-stretch, la Crème sans stéroïdes Atopiclair pour les symptômes de la dermatite atopique et la Crème sans stéroïde Sebclair pour les symptômes de la dermatite séborrhéique. Notre mission est de fournir ces produits aux praticiens et à leurs patients qui en ont besoin à travers le Canada.

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MNP www.mnp.ca

#112 Contest Contribution: iPad mini with notebook case

MNP is one of the largest accountancy and business advisory firms in Canada. Whether you are in residency, starting a new practice, or planning for your retirement, MNP provides a full range of business advisory services to assist you at every stage.

MNP est l’un des plus grands cabinets de comptabilité et de services-conseils au Canada. Que vous soyez en résidence, démarriez un nouveau cabinet ou planifiiez votre retraite, MNP vous offre une gamme complète de servicesconseils pour vous assister, à toutes les étapes.

Myeloma Canada www.myelomacanada.ca

#545

Myeloma, a rare, incurable, but treatable cancer of bone marrow plasma cells, is sometimes misdiagnosed, or diagnosed late. This can result in very painful and debilitating bone damage, other significant bodily damage, premature death, or long-lasting quality-of-life impacts. Key symptoms and tests can help family physicians detect possible myeloma early.

Le myélome est un cancer des plasmocytes de la moelle osseuse rare et incurable, mais qui répond très bien au traitement. Il est parfois diagnostiqué à tort ou trop tard. La personne touchée par cette maladie peut alors souffrir de dommages osseux invalidants et d'autres lésions corporelles importantes, menant à une qualité de vie réduite et même à un décès prématuré. Les symptômes clés et des tests peuvent aider les médecins de famille à effectuer un dépistage précoce de ce cancer.

Mylan www.mylan.com

#722

Visit Mylan at booth 722 to learn more about Androgel, a 1 per cent testosterone gel applied topically and used to treat men with low testosterone; MAVIK, a long-acting ACE inhibitor indicated for treatment of hypertension; Synthroid, which offers precise dosing and flexibility with 12 different dose strengths for the treatment of hypothyroidism; and Creon, unique patented Minimicrospheres for treatment of cystic fibrosis and pancreatic exocrine insufficiency.

Visitez Mylan au kiosque 722 afin d’en apprendre plus sur Androgel, gel de testostérone à 1 % s'appliquant sur la peau et utilisé pour traiter les hommes ayant un déficit en testostérone; MAVIK, IECA à action prolongée et indiqué dans le traitement de l’hypertension; Synthroid, qui permet d’ajuster précisément la dose à administrer dans le traitement de l'hypothyroïdie grâce à la souplesse posologique offerte par les 12 différentes concentrations, et Creon, minimicrosphères uniques et brevetées, indiquées pour le traitement de la fibrose kystique et de l’insuffisance pancréatique exocrine.

Nestlé Nutrition www.corporate.nestle.ca

#613

Nestlé Nutrition’s mission is to enhance life through innovative and scienceproven products, offering nutritional solutions to our consumers. We support the first 1,000 days of life through Materna® multivitamins, Good Start® infant formulas, and Gerber® cereals, snacks, and meals. We share our nutrition science in accessible ways with parents and HCPs so that they can make appropriate and informed choices.

La mission de Nestlé Nutrition est d’améliorer la vie par des produits innovateurs et éprouvés scientifiquement, en offrant des solutions nutritionnelles aux consommateurs. Nous soutenons les 1000 premiers jours de vie avec les multivitamines MaternaMD, les préparations pour nourrissons Bon DépartMD ainsi que les céréales, collations et repas GerberMD. Nous partageons nos connaissances scientifiques nutritionnelles de manière accessible avec les parents et les professionnels de la santé afin qu’ils puissent faire des choix appropriés et éclairés.

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EXHIBITS | EXPOSITION Northern Medical Services www.northerndocs.com

#605

Novo Nordisk Canada – Diabetes www.novonordisk.ca

Northern Medical Services, a division of the Department of Academic Family Medicine, University of Saskatchewan, recruits for full-time, global health, itinerant contract, and locum family physician positions in northern Saskatchewan. NMS physicians are active participants in health care delivery to predominantly Aboriginal communities. Visit our booth to learn more about our “Opportunities with a Difference.”

Northern Medical Services, division du Département de la médecine familiale universitaire de l’Université de la Saskatchewan, cherche à combler des postes de médecins de famille soit à temps plein, soit en santé mondiale, itinérants à contrat ou remplaçants dans le nord de la Saskatchewan. Les médecins de NMS participent activement à la prestation de soins de santé dans des collectivités à prédominance autochtone. Visitez notre stand pour vous renseigner sur notre programme « Opportunities with a Difference »

Northern Ontario School of Medicine www.nosm.ca

#246

Contest Contribution: Cash The Northern Ontario School of Medicine offers hands-on family medicine training like no other. Get information on our unique distributed training sites, including rural options not available at traditional urban training centres as well as a multitude of funded PGY3 options. Find out why residents in NOSM’s program can expect to gain the competency and confidence to practise in any health care setting!

L’École de médecine du Nord de l’Ontario offre une formation en médecine familiale pratique comme nulle autre. Informez-vous sur nos sites de formation décentralisés offrant des possibilités en milieu rural qui ne sont pas disponibles dans les centres de formation urbains traditionnels – ainsi qu’une multitude de possibilités de programmes financés de troisième année.

Apprenez pourquoi les résidents inscrits au programme de l’ÉMNO sont en droit de s’attendre à acquérir les compétences et la confiance pour pratiquer dans n’importe quel milieu de soins de santé.

NorthWest Healthcare Properties www.nwhp.ca

#208

NorthWest Healthcare Properties REIT provides real estate solutions tailored to the health care industry. We understand that health care tenants have specialized real estate needs. From the sale of medical buildings to leasing new space to individual professional requirements or evolving health care practice trends, we have solutions for your real estate needs.

Northwest Healthcare Properties REIT fournit des solutions immobilières adaptées à l'industrie des soins de santé. Nous comprenons que les professionnels de la santé ont des besoins immobiliers particuliers. De la vente d’édifices médicaux à la location d'un nouvel espace; des exigences personnelles de professionnels aux nouvelles tendances dans la pratique médicale, nous offrons des solutions pour tous vos besoins immobiliers.

Nova Scotia Department of Health & Wellness http://physicians.novascotia.ca/

#426

Contest Contribution: Gift cards – Best Buy Find out what’s new in Nova Scotia! Nova Scotia offers more than an innovative approach to health care and a balanced approach to life. We offer a variety of compensation models and recruitment programs. Build the lifestyle of your dreams surrounded by land and sea, beach and forest, mountains and valleys.

Découvrez les nouveautés en Nouvelle-Écosse! La Nouvelle-Écosse vous offre non seulement un mode de vie équilibré et une approche novatrice des soins de santé, mais aussi une variété de modèles de rémunération et des programmes de recrutement. Créez le mode de vie dont vous rêvez dans un endroit magnifique entouré par l'océan et ses plages, les forêts, les montagnes et les vallées.

fmf.cfpc.ca

familymedicineforum

#232

Novo Nordisk manufactures and markets pharmaceutical products and services that make a significant difference to patients, the medical profession, and society. As the world leader in diabetes care, we offer a broad product portfolio, including the most advanced insulin delivery systems. In addition, Novo Nordisk is focused on obesity, coagulation disorders, and hormone replacement therapy.

Novo Nordisk fabrique et commercialise des produits pharmaceutiques et offre des services qui ont un impact important sur les patients, la profession médicale et la société. À titre de chef de file mondial en soins du diabète, Novo Nordisk offre un vaste portefeuille de produits, notamment les systèmes d'administration de l'insuline les plus perfectionnés. Novo Nordisk s’intéresse également à l’obésité, aux troubles de la coagulation et à l’hormonothérapie substitutive.

Novo Nordisk Canada – Obesity www.novonordisk.ca

#332

Novo Nordisk manufactures and markets pharmaceutical products and services that make a significant difference to patients, the medical profession, and society. As the world leader in diabetes care, we offer a broad product portfolio, including the most advanced insulin delivery systems. In addition, Novo Nordisk is focused on obesity, coagulation disorders, and hormone replacement therapy.

Novo Nordisk fabrique et commercialise des produits pharmaceutiques et offre des services qui ont un impact important sur les patients, la profession médicale et la société. À titre de chef de file mondial en soins du diabète, Novo Nordisk offre un vaste portefeuille de produits, notamment les systèmes d'administration de l'insuline les plus perfectionnés. Novo Nordisk s’intéresse également à l’obésité, aux troubles de la coagulation et à l’hormonothérapie substitutive

Nurse Practitioners’ Association of Ontario (NPAO) #118 www.npao.org Nurse Practitioners’ Association of Ontario (NPAO) is the professional voice for nurse practitioners in Ontario. Our mission is to achieve full integration of nurse practitioners to ensure accessible, high-quality health care for all.

L'Association des infirmières et infirmiers praticiens de l'Ontario (AIIPO) est la porte-parole professionnelle de tous les infirmières et infirmiers praticiens en Ontario. Notre mission est de réaliser l'intégration complète des infirmières et infirmiers praticiens afin d'assurer des soins de santé de haute qualité et accessibles pour tous.

NZLocums www.nzlocums.com

#618

NZLocums is New Zealand’s government-funded family physician recruitment organization, providing short-term, long-term, and permanent recruitment services to rural family practice in New Zealand. We provide comprehensive recruitment service, competitive remuneration, and a CME accredited orientation course introducing you to the New Zealand health system upon arrival.

NZLocums est l'organisme financé par le gouvernement de la NouvelleZélande pour le recrutement des médecins de famille. Nous offrons des services de recrutement à court terme, à long terme et permanents pour des pratiques de médecine familiale des milieux ruraux de la Nouvelle-Zélande.

Nous fournissons des services de recrutement complets, une rémunération concurentielle et un cours d'orientation de FMC agréé dès votre arrivée afin de vous famliariser avec le système de soins de santé de la Nouvelle-Zélande.

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EXHIBITS | EXPOSITION Ocean by CognisantMD www.cognisantMD.com

#543

Contest Contribution: Android Tablet with Ocean software and 3-month subscription CognisantMD’s cloud-based Ocean Platform unlocks and extends your EMR, allowing patients to securely share information for clinical use or research. By adding Ocean Tablets and Ocean’s large library of clinical content to existing EMRs, the platform provides a powerful, secure, mobile way to connect patients to their physicians and beyond.

Ocean Platform basé en nuage de CognisantMD déverrouille et élargit votre DMÉ, ce qui permet aux patients de partager de l'information pour la recherche ou l'usage clinique de façon sécurisée. En ajoutant les Ocean Tablets et la bibliothèque Ocean à vos dossiers médicaux électroniques existants, la plateforme fournit un moyen sûr, puissant et portable de relier les patients à leurs médecins et au-delà.

OMA Section on General and Family Practice www.oma.org

#M14

Please join your OMA Section—the Section on General & Family Practice (SGFP)—–at its booth to find out more about the Section’s initiatives and membership services. Copies of the brand new Billing & Practice Guide and Common Family Practice Codes will be available.

Joignez-vous à votre Section de l’OMA – la Section on General & Family Practice (SGFP). Rendez-vous à notre kiosque pour de plus amples renseignement sur les initiatives et services aux membres de la Section. Vous pouvez aussi vous procurer des copies des nouveaux guides de facturation (Billing & Practice Guide) et des codes (Common Family Practice Codes).

Ontario Chiropractic Association www.chiropractic.on.ca

#826

Contest Contribution: Fitbit, plus a chiropractic/musculoskeletal book.

Established in 1929, the Ontario Chiropractic Association (OCA) is a voluntary professional association whose mission is to serve its members and the public by advancing the understanding and use of chiropractic care.

Visit us at www.chiropractic.on.ca to learn more about spinal health or to locate a chiropractor in your community.

Fondée en 1929, l’Ontario Chiropractic Association est une association professionnelle, dont l’adhésion est volontaire, ayant pour mission de servir ses membres et le public en assurant la compréhension et l’exercice de soins chiropractiques. Visitez-nous à www.chiropractic.on.ca pour obtenir de plus amples renseignements sur la santé vertébrale ou pour trouver un chiropracticien dans votre communauté.

Ontario Renal Network www.renalnetwork.on.ca

#708

The KidneyWise Clinical Toolkit provides guidance to primary care providers on which patients are at high risk of developing chronic kidney disease and recommendations on how to properly diagnose and best manage the patient to reduce the risk for further disease progression.

La boîte à outils clinique KidneyWise offre aux fournisseurs de soins primaires des conseils utiles pour déterminer quels sont les patients qui risquent le plus de contracter une maladie du rein chronique, ainsi que des recommandations sur la manière de diagnostiquer correctement et de prendre en charge le patient pour réduire le risque de progression de la maladie.

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Ontario Telemedicine Network (OTN) www.otnhub.ca

#726

The Ontario Telemedicine Network (OTN) equips health care providers with innovative solutions to deliver more efficient care to patients, empower patient self-management, and increase the way information and knowledge is shared across the medical community. Learn about the range of telemedicine tools and services right for you.

OTN munit les professionnels de la santé de solutions novatrices afin de fournir à leurs patients des soins plus efficaces, d’aider les patients à gérer leur santé et d’améliorer la manière dont les informations et les connaissances sont partagées dans la communauté médicale. Renseignez-vous sur notre gamme d'outils et de solutions de télémédecine qui conviennent à vos besoins.

OntarioMD www.ontariomd.com

#624

OntarioMD is a wholly-owned subsidiary of the Ontario Medical Association.

OntarioMD manages the Electronic Medical Records (EMR) Adoption Program and offers value-added services such as the EMR Enhanced Use Program, Peer Leader Program, and Hospital Report Manager to assist physicians with optimizing EMR use.

OntarioMD est une filiale en propriété exclusive de l’Ontario Medical Association. OntarioMD gère le programme d’adoption des dossiers électroniques (Electronic Medical Records Adoption Program) et offre des services à valeur ajoutée tels que les programmes EMR Enhanced Use Program, Peer Leader Program et le Hospital Report Manager afin d'aider les médecins à optimiser leur usage du DMÉ.

OSCAR EMR www.oscar-emr.org

#133

OSCAR is a cost-effective, browser-based EMR developed and supported by a collaborative open-source community. OSCAR’s quality management processes and certifications are managed by the not-for-profit organization OSCAR EMR. OSCAR has been implemented in six provinces across Canada.

It is an Ontario EMR Specification 4.1a Funding Eligible EMR Offering and has been validated at the IHE for complying with international interoperability standards.

OSCAR est un DMÉ efficace en termes de coût, accessible par un navigateur et élaboré et soutenu par une communauté des logiciels ouverts collaboratifs.

Les processus de gestion de la qualité et les certifications d'OSCAR sont gérés par l'organisme à but non lucratif OSCAR EMR. Mis en œuvre dans 6 provinces canadiennes, OSCAR est un DMÉ de spécification 4.1a admissible pour du financement en Ontario qui a été validé par l'IHE pour son respect des normes d'interopérabilité internationale.

Otto Trading, Inc. www.unimedmassager.com

#229

Manufacturer and distributor of hand-held portable digital massager, TENS unit.

Nous produisons et distribuons l'appareil TENS, un masseur numérique portatif.

Paladin Labs www.paladinlabs.com

#702

Paladin Labs is a specialty pharmaceutical company and member of Rx&D, focused on acquiring or in-licensing innovative pharmaceutical products for the Canadian market and select international markets.

Les laboratoires Paladin sont une société pharmaceutique de spécialité membre de Rx&D dont l’activité principale consiste à acheter des produits pharmaceutiques novateurs ou à en obtenir les droits de commercialisation pour le Canada et d’autres marchés internationaux.

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EXHIBITS | EXPOSITION Pallium Canada www.pallium.ca

#M15

Pallium Canada offers professional development opportunities and develops interprofessional clinical decision-making tools and e-learning resources for palliative care. Professional development includes the Learning Essential Approaches to Palliative and End-of-Life Care and Facilitator Training. Clinical decision-making tools include the Pallium Palliative Pocketbook, e-Book, and Resource App. E-Learning resources include the Pallium Portal, Doodles, Snippets, and Courselets.

Pallium Canada offre des occasions de développement professionnel et crée des outils pour la prise de décisions cliniques interprofessionnelles et des ressources pour l'apprentissage en ligne pour les soins palliatifs. Le développement professionnel comprend Learning Essential Approaches to Palliative and End-of-Life Care ainsi que la formation des animateurs.

Les outils pour la prise des décisions cliniques incluent le Livre de Poche de Pallium, le livre numérique et l’application. L'apprentissage en ligne comprend le portail Palllium, Doodles, Snippets et Courselets.

Parkinson Society Canada www.parkinson.ca

#825

Parkinson Society Canada (PSC) is the national voice of Canadians living with Parkinson’s. From diagnosis to discovery, since 1965 PSC provides education, advocacy, and support services to individuals and health care professionals.

The National Research Program funds innovative research to search for better treatments and a cure. Visit www.parkinson.ca La Société Parkinson Canada (SPC) est la voix nationale des Canadiens et Canadiennes atteints de la maladie de Parkinson. Depuis 1965, la SPC fournit du soutien et de l'éducation, et défend les intérêts des personnes atteintes de cette maladie ainsi que ceux des professionnels de la santé, du diagnostic à la découverte. Le Programme national de recherche finance les recherches novatrices afin de découvrir de meilleurs traitements et une guérison. Veuillez visiter www.parkinson.ca

Pediapharm www.pedia-pharm.com

#M6

Pediapharm is the only pediatric specialty pharmaceutical company in Canada, providing sales and marketing expertise for the pediatric market segment. Pediapharm’s key objectives are to partner with health care entities around the world and bring new, innovative, or existing OTC and Rx pediatric products to the Canadian market.

Pediapharm est la seule entreprise pharmaceutique spécialisée en pédiatrie au Canada qui offre une expertise en vente et en commercialisation dans le segment pédiatrique du marché. Pediapharm souhaite s'associer à des organismes de soins de santé partout dans le monde et apporter au marché canadien de nouveaux produits pédiatriques innovateurs ou des produits existants, en vente libre ou sur ordonnance.

Pendopharm, a Division of Pharmascience Inc. www.pendopharm.com

# 612

Contest Contribution: Cash Pendopharm – Open Minds Think Alike.

Pendopharm is a rapidly growing, independent business that focuses on commercializing a portfolio of specialty prescription products and an established line of OTC/BTC products.

Pendopharm – Les Grands Esprits se Rencontrent. Pendopharm est une entreprise pharmaceutique indépendante ayant une forte croissance et dont les activités de commercialisation se concentrent sur un portefeuille de produits d’ordonnance spécialisés ainsi qu’une gamme importante et établie de produits offerts en vente libre et sur prescription.

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Portico Network www.porticonetwork.ca

#109 Contest Contribution: Cash

Portico is Canada’s online mental health and addictions network for professionals, providing access to free tools, resources, and professional development. Portico connects health care providers, allied professionals, clients, families, and organizations through collaboration and knowledge exchange.

Come by our booth and we’ll show you how you can get involved.

Portico est le réseau canadien en ligne par excellence pour les professionnels de la santé mentale et du traitement de la toxicomanie, hébergeant des outils, des ressources et des cours de perfectionnement professionnel gratuits.

Portico permet de rassembler les prestataires de soins de santé, les membres de professions apparentées, les clients, leur famille et les organismes et établissements en leur offrant un espace propice à la collaboration et à l’échange de connaissances. Passez nous voir à notre kiosque et nous vous donnerons toute l’information sur le réseau et vous expliquerons comment vous y joindre.

Proctor & Gamble www.pg.ca

#336 & 337

P&G is happy to be participating in the Family Medicine Forum 2015 on behalf of Align, Metamucil, Zzzquil, Head & Shoulders, Tide, Downy, and Bounce Free & Gentle. P&G draws on a strong heritage of trusted, quality international leadership brands that serve approximately 4.6 billion people in 80 countries.

P&G est heureux de participer au Forum en médecine familiale 2015 au nom de Align, Metamucil, Zzzquil, Head & Shoulders, Tide, Downy et Bounce Free & Gentle. P&G possède un riche héritage de produits fiables et de marque de qualité, internationalement reconnus, qui répondent aux besoins de quelque 4,6 milliards de personnes dans 80 pays.

Project ECHO Ontario – Chronic Pain www.echoontario.ca

#M3

Echo Ontario Chronic Pain and Opioid Stewardship: ECHO Ontario supports Primary Care Providers (PCPs) in management of their chronic pain patients.

During two-hour weekly videoconferencing sessions, PCPs across Ontario connect with inter-professional teams for case-based learning, didactics, and discussion. ECHO moves knowledge and builds capacity and support for PCPs and their patients. Visit the ECHO booth to learn more.

ECHO Ontario aide les fournisseurs de soins primaires à prendre en charge leurs patients souffrant de douleur chronique. Au moyen de séances hebdomadaires d'une durée de 2 heures, offretes par vidéoconvérence , les fournisseurs de soins primaires de partout en Ontario peuvent communiquer avec des équipes interprofessionelles pour profiter de l'apprentissage par l'étude de cas, de l'approche didactique et de discussions. ECHO aide à accroître les connaissances et à améliorer les capacités et apporte du soutien aux fournisseurs de soins primaires ainsi qu’à leurs patients. Visitez le stand ECHO pour de plus amples renseignements.

Prostate Cancer Canada www.prostatecancer.ca

#630

Prostate cancer is the most common cancer to affect Canadian men, impacting one in seven men over the course of their lifetime. Prostate Cancer Canada funds programs related to awareness and public education, advocacy, support of those affected, and research into the prevention, detection, treatment, and cure of prostate cancer.

Le cancer de la prostate est le cancer le plus courant chez les Canadiens : un homme sur sept en sera atteint au cours de sa vie. Cancer de la Prostate Canada finance des programmes indispensables de sensibilisation et d’éducation du public, de défense des droits, de soutien des hommes atteints et de recherche sur la prévention, le dépistage, le traitement et la guérison du cancer de la prostate.

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EXHIBITS | EXPOSITION Province of New Brunswick www.gnb.ca/health

#132

New Brunswick invites you … to meet Recruitment Officers representing each Regional Health Authority; to meet Human Resource Advisors from the NB Department of Health; to inquire about employment opportunities in New Brunswick; to learn about service delivery models in NB; to discuss exciting partnerships; and to familiarize yourself with recruitment strategies for physicians.

Le Nouveau-Brunswick vous invite… à rencontrer des agents de recrutement représentant chaque Régie régionale de la santé; à rencontrer des conseillers en ressources humaines représentant le ministère de la Santé; à découvrir les possibilités d’emplois au Nouveau-Brunswick; à en apprendre davantage sur les modèles de prestation de soins du Nouveau-Brunswick; à discuter de partenariats intéressants; et à vous familiariser avec les stratégies de recrutement.

Purdue Pharma www.purdue.ca

#333

Purdue Pharma is dedicated to developing and providing innovative medicines for patients and health care professionals and to supporting quality education for the safe use of its products.

Purdue Pharma se consacre au développement et à la mise en marché de traitements innovants pour les patients et les professionnels de la santé ainsi qu'au soutien d'une formation de qualité pour l'utilisation sécuritaire de ses produits.

Queen’s University www.familymedicine.queensu.ca

#247

Queen’s two-year postgraduate program features the CFPC Triple C curriculum delivered within interprofessional family medicine environments.

We offer four diverse training sites, an electronic evaluation portfolio, a focus on comprehensive training, and flexible programming. We also offer a variety of PGY3 opportunities. For more information visit our website.

Le programme de formation postdoctorale de deux ans de l’Université Queen est basé sur le Cursus Triple-C du CMFC et est offert dans des contextes interprofessionnels. Nous avons quatre différents centres de formation, un système électronique d’évaluation par portfolio, une concentration sur la formation complète et globale et des programmes flexibles. Nous offrons également une variété de programmes de 3e année. Pour en savoir plus, visitez notre site Web.

Resident Doctors of Canada www.residentdoctors.ca

#244 Contest Contribution: Cash

Resident Doctors of Canada is the national representative body of more than 9,000 resident doctors in Canada. Established as a not-for-profit organization in 1972, the organization acts as the unified, national voice of our membership.

Médecins résidents du Canada est l'organisme répresentatif national pour plus de 9 000 médecins résidents au Canada. Fondé en tant qu'organisme à but non lucratif en 1972, il parle d’une voix unie à l’échelle nationale pour ses membres.

Rexall www.rexall.ca

#732

Rexall Pharmacy’s Medical Clinic division works with family physicians in identifying potential sites to establish or locate a medical clinic. Rexall’s national expertise in site identification, design and construction can help family physicians as they relocate and/or set-up a new clinic (either walk-in, solo practice or group practice).

La division des cliniques médicales Rexall Pharmacy travaille avec les médecins de famille afin d'identifier des sites potentiels pour établir une clinique médicale. L'expertise d'envergure nationale de Rexall dans l’identification de site, la conception et la construction de cliniques peut aider les médecins de famille lorsqu'ils doivent transférer une clinique existante ou en ouvrir une nouvelle clinique (clinique sans rendez-vous, pratique de groupe ou solo).

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Room 217 Foundation www.room217.ca

#611 Contest Contribution: DVD boxed gift set

The Room 217 Foundation is a not-for-profit corporation and registered Canadian charity dedicated to caring for the whole person with music.

Room 217 produces and delivers therapeutic music products, provides skills and training for integrating music into care, gets music care resources to people who need them most, and supports music care research.

La fondation Room 217 est une société à but non lucratif et un organisme caritatif canadien enregistré qui se consacre aux soins de la personne entière au moyen de la musique. Room 217 crée et distribue des produits musicaux thérapeutiques et offre la formation et les compétences nécessaires pour intégrer la musique dans le domaine des soins. Il fournit des ressources pour la musique thérapeutique à ceux qui en ont besoin et soutient les recherches sur la musique thérapeutique.

RPS Diagnostics www.rpsdetectors.com

#526

RPS Diagnostics is an emerging developer, manufacturer, and marketer of rapid, point-of-care diagnostic tests for infectious diseases and inflammatory conditions. FebriDx™ is a 15-minute, in-office test that uses a fingerstick blood sample to help identify and differentiate a clinically significant immune response to viral and/or bacterial acute febrile respiratory infection.

RPS Diagnostics est un développeur émergeant qui conçoit, fabrique et commercialise des tests de diagnostic utilisables sur le point d’intervention, pour les maladies infectieuses et les états inflammatoires. Le FebriDx™ est un test en cabinet de 15 minutes qui utilise un échantillon sanguin par prélèvement au doigt afin d'identifier une réponse immunitaire cliniquement significative et une infection respiratoire fébrile aiguë virale et/ou bactérienne et de les différencier.

RSRS – Record Storage & Retrieval Services, Inc. www.recordsolutions.ca

#223

Canada’s leader in medical records management since 1997, RSRS provides medical practice closure and transition services, paper and digital record storage and retrieval, document scanning, release-of-information, and medical record transfers. RSRS also offers document indexing and uploading to EMR (for active practices). RSRS is Canada’s only physician-managed, fully compliant medical records facility.

Chef de file de la gestion des dossiers médicaux au Canada depuis 1997, RSRS fournit des services de fermeture et de transition de pratiques médicales, l'entreposge et la récuperation de dossiers papiers et numériques, la numérisation de documents, la divulgation d'information et les transferts de dossiers médicaux. RSRS offre également l'indexation des documents et le téléchargement de DMÉ pour les pratiques médicales actives. RSRS est le seul établissement pour les dossiers médicaux entièrement conforme et géré par des médecins au Canada.

Rural Ontario Medical Program www. romponline.com

#M9

The Rural Ontario Medical Program (ROMP) delivers quality, comprehensive rural and regional health professional education by the engagement of South Central Ontario communities. ROMP provides community-based clinical rotations for Ontario's six medical schools as well as other learners from Canadian health professional programs.

Rural Ontario Medical Program (ROMP) offre la formation complète et de qualité aux professionnels qui travaillent en milieu ruraux et régionaux dans les communautés du centre-sud de l'Ontario. Le ROMP fournit des stages rotatoires cliniques en milieu communautaire pour les six facultés de médecine en Ontario ainsi que pour les étudiants d'autres programmes de professionnels de la santé canadiens.

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EXHIBITS | EXPOSITION RxFiles www.rxfiles.ca

#603

Contest Contribution: RxFiles Drug Comparison Charts book; Geri RxFiles book RxFiles Academic Detailing seeks to provide balanced discussion around drug therapy decision making. Come by and check out the following: a) Geri-RxFiles, b) RxFiles Drug Comparison Charts book, c) electronic platforms, and d) recent reviews/ publications. We hope to meet as many of you as possible. Note: our booth is usually quite busy at the breaks!

RxFiles Academic Detailing vise à fournir une discussion équilibrée sur la prise de décision pharmacothérapique. Venez voir tout ce que nous offrons tels que a) Geri-RxFiles, b) RxFiles Drug Comparison Charts, c) nos plateformes électroniques et d) nos revues et publications récentes. Nous souhaitons rencontrer autant de membres que possible. Notre kiosque est très bien fréquenté lors des pauses!

Sanofi Canada www.sanofi.ca

SeeMore Imaging Canada www.seemore.ca

SeeMore USB ultrasound probes are affordable and application-specific— abdominal, endocavity, vascular access, MSK, and regional nerve block.

The system is compatible with most laptop, netbook, and tablet computers running Windows; all software is included and can be downloaded to any number of computers—the ultimate in portability.

Les sondes exploratrices par ultrasons SeeMore USB sont abordables et spécifiques, selon qu’il s’agisse d’utilisation abdominale, endocavitaire, par accès vasculaire, musculo-squelettique et pour le bloc nerveux régional.

Ce système est compatible avec la plupart des ordinateurs portables, des netbooks et des tablettes compatibles avec Windows. Tous les logiciels sont inclus et peuvent être téléchargés vers autant d’ordinateurs que l’on veut. Le nec-plus-ultra en matière de portabilité.

Shire www.shirecanada.ca

Sanofi Canada apporte valeur, santé et espoir aux Canadiens grâce à des solutions de soins de santé novatrices. En tant que chefs de file de l’éducation sur la maladie chronique et de sa prise en charge, nous faisons équipe avec des professionnels de la santé et des patients pour offrir des solutions thérapeutiques, des dispositifs primés ainsi qu’une surveillance efficace et des services personnalisés en ce qui concerne le diabète et les allergies graves.

saskdocs www.saskdocs.ca

#607 Contest Contribution: Cash

saskdocs is a one-stop shop for physicians wanting to live and work in Saskatchewan. We look forward to meeting you in Toronto this November. Drop by our booth, give us a call at 1-888-415-3627, visit our website, or email jobs@saskdocs.ca to find out more about the many exciting opportunities awaiting you in Saskatchewan! saskdocs est un point de convergence pour les médecins qui désirent vivre et travailler en Saskatchewan. Nous espérons vous rencontrer à Toronto en novembre. Visitez notre stand, appelez-nous au 1 888 415-3627, consultez notre site Web ou envoyez-nous un courriel au jobs@saskdocs.ca pour en savoir plus sur toutes les possibilités intéressantes qui vous attendent en Saskatchewan!

Scotiabank www.scotiabank.ca

#306 Contest Contribution: Cash

Scotiabank understands that finances play an important role in a rewarding and successful profession. With our Scotia Professional® Plan, a customizable banking package, we can provide you with the support you need to reach your personal and professional goals, including tailored financing options, banking services, investment management, and more. À la Banque Scotia, nous savons combien les finances jouent un rôle important dans le cadre d’une profession enrichissante et couronnée de succès. Avec notre programme Professions libérales Scotia, forfait bancaire personnalisable, nous pouvons vous offrir le soutien dont vous avez besoin pour réaliser vos objectifs personnels et professionnels, en plus de vous proposer des options de financement, des services bancaires et des solutions de gestion des placements taillés sur mesure, et plus encore.

fmf.cfpc.ca

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#231

Shire enables people with life-altering conditions to lead better lives. Neuroscience, including ADHD, is one of our main areas of specialty. Visit www.shirecanada.com for more information.

#736

Sanofi Canada brings value, health, and hope to Canadians through innovative health care solutions. As leaders in chronic disease education and management, we partner with health care professionals and patients to offer therapeutic solutions, award-winning devices, effective monitoring, and personalized services in diabetes and severe allergies.

#M19

Shire aide les personnes atteintes de maladies graves à vivre mieux. La neuroscience, incluant le TDAH, est l’une de nos principales spécialités.

Consultez www.shirecanada.com pour de plus amples renseignements.

Shop For Jayu www.shopforjayu.com

#811

Shop for Jayu (meaning “Freedom” in Korean) reflects a handcrafted yet dynamic vibe and offers trendy, bold, fashionable, and popular designs at prices comparable to major retailers. It is incomparable in the degree and excellence of quality to other competitors. Shop for Jayu attracts a broad range of styles from urban and glamour, to bohemian and ultra-feminine.

Shop for Jayu (en coréen : liberté) vous offre des pièces fabriquées à la main, modernes, dynamiques, élégantes et contemporaines à des prix comparables à ceux des grands détaillants. Nous vous offrons un niveau de qualité et d'excellence supérieur à celui de nos concurrents. Votre style est-il urbain, contemporain, bohémien ou ultra-féminin? Nous avons des articles pour tous les goûts.

Sigvaris www.sigvaris.ca

#629

Sigvaris is recognized as a global industry leader in the area of compression therapy for the management of chronic venous disorders. Sigvaris product lines include Sigvaris Medical, Sigvaris Well Being, and Sigvaris Sports.

Sigvaris est un chef de file mondial reconnu dans le domaine de la compressothérapie pour la prise en charge des troubles veineux chroniques.

Parmi la gamme de produits Sigvaris figurent Sigvaris Medical, Sigvaris BienẾêtre et Sigvaris Sports.

Sioux Lookout Regional Physician Services www.siouxlookoutareadocs.ca

#746

Surrounded by natural beauty, Sioux Lookout and Region continues to thrive and remain an exciting place to practise medicine. A state-of-the-art hospital is the perfect base to provide physician services to 31 remote First Nation communities. Diverse work, engrossing culture, competitive compensation.

Sioux Lookout is worth exploring!

Entourés de beauté naturelle, Sioux Lookout et sa région continuent à prospérer et demeurent un lieu idéal pour pratiquer la médecine. Un hôpital à la fine pointe de la technologie est un endroit parfait pour offrir des services en médecine aux 31 communautés éloignées des Premières nations. Diversité dans le travail, culture captivante, rémunération concurrentielle. Venez explorer Sioux Lookout!

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EXHIBITS | EXPOSITION Society of Obstetricians and Gynaecologists of Canada www.sogc.org

#302

Contest Contribution: Cash The SOGC is one of Canada’s oldest national specialty organizations. Established in 1944, the Society’s mission is to promote excellence in the practice of obstetrics and gynaecology and to advance the health of women through leadership, advocacy, collaboration, outreach, and education.

For more information, visit www.sogc.org La Société des obstétriciens et gynécologues du Canada (SOGC) est l'un des plus anciens organismes nationaux de médecine spécialisée du pays. Fondée en 1944, la SOGC a pour mission de promouvoir l'excellence dans la pratique de l'obstétrique-gynécologie et la santé des femmes par le leadership, la défense des droits, la collaboration, la prise de contact et l'éducation. Pour de plus amples renseignements, consultez le www.sogc.org

Sun Life Financial www.sunlife.ca/norman.manikkawasagan

#723

Contest Contribution: Gift cards - Visa I specialize in building risk-managed, taxefficient strategies for clients with sophisticated financial needs, especially those in the medical field. I dedicate myself to a niche group of clients to ensure the highest level of service possible. I also engage lawyers and accountants to help maximize your savings and investments.

Spécialiste de l'élaboration de stratégies fiscalement efficaces, y compris la gestion du risque pour les clients ayant des besoins financiers complexes comme ceux qui travaillent dans le domaine médical. Je cible un créneau de clients pour leur assurer le plus haut niveau de service possible. Je travaille également avec des avocats et des comptables afin de maximiser vos économies et vos placements.

Supon Voice www.suponvoice.com

#123

Supon Voice is a Speech to Text software provider. We specialize in Dragon Naturally Speaking Software, Medical, Legal, and Professional editions. We carry Olympus and Philips speech products: digital recorders, transcription kits, foot pedals, headsets, and accessories. We also repair your old dictation equipment. Check out our website for all your dictation needs.

Supon Voice est un fournisseur de logiciels de conversion de la parole au texte. Nous sommes des spécialistes des versions médicales, juridiques et profesionnelles du logiciel Dragon Naturally Speaking. Nous offrons les produits pour la parole Olympus et Philips, les enregistreurs numériques, les kits de transcription, les pédales, les casques et autres accessoires. Nous réparons également votre ancien équipement de dictée. Consultez notre site pour tous vos besoins en matière de dictée.

Surgo Surgical Supply www.surgo.com

#233 Contest Donation: Cardiology 3 Stethoscope

Surgo is the only Canadian full-line supplier of medical supplies, equipment, and printing. We provide premium services to support clinic managers with management tools and the fastest wireless online ordering of supplies and account management for large, busy, and growing clinics. Surgo provides better service with time- and money-saving technologies, AIR MILES® Reward Miles, and a lowest-price guarantee.

Surrey-North Delta Division of Family Practice www.divisionsbc.ca/snd

The Surrey-North Delta Division of Family Practice is recruiting physicians and locums to our community for exciting opportunities in family practice, hospital-based work, and multidisciplinary care. Please visit our booth to learn more and to receive an invite to our cocktail reception.

The Surrey-North Delta Division of Family Practice recrute des médecins à temps plein et de suppléance qui souhaitent trouver de bonnes occasions en médecine familiale, en milieu hospitalier et dans les soins multidisciplinaires.

Visitez notre kiosque pour de plus amples renseignements et pour recevoir votre invitation à notre cocktail.

TD Insurance www.tdinsurance.com

#513 Contest Contribution: Gift card - Visa

Discover why over 230,000 professionals enjoy greater savings with TD Insurance Meloche Monnex. Thanks to our partnership with the CFPC, you can benefit from preferred group rates and enhanced coverage for your home and automobile insurance needs. We also offer flexible limits for made-to-measure protection. Call 1-888-589-5656 or visit melochemonnex.com/cfpc to request a quote.

Découvrez pourquoi plus de 230 000 professionnels profitent d’importantes économies avec les assurances TD Meloche Monnex. Grâce à notre collaboration avec le CMFC, vous pouvez bénéficier de tarifs préferentiels et des protections accrues pour vos assurances habitation et automobile. Nous offrons également des limites souples pour des couvertures personnalisées.

Composez le 1 888-589-5656 ou visitez melochemonnex.com/cfpc pour obtenir une soumission.

Tea Association of Canada www.tea.ca

#625

Tea for Your Health! Tea is a caloriefree and all-natural beverage that can help Canadians stay healthy. Learn about the scientific research on tea and health and receive valuable resources for you and your patients. It’s tea time with the Tea Association of Canada, a national not-for-profit organization. http://www.tea.ca/ Un thé pour votre santé! Le thé est une boisson entièrement naturelle et sans calories qui peut aider les Canadiens et Canadiennes à se maintenir en bonne santé. Renseignez-vous sur les recherches scientifiques sur le thé et la santé et obtenez des ressources utiles pour vous et vos patients. C'est l'heure du thé à l'Association du Thé du Canada, organisme national sans but non lucratif. http://www.tea.ca/

Telus Health www.telushealth.com

#537

TELUS Health is a leader in tele-homecare, electronic medical and health records, consumer health, benefits management, and pharmacy management.

TELUS Health gives health authorities, providers, physicians, patients, and consumers the power to turn information into better health outcomes. For more information about TELUS Health, please visit telushealth.com TELUS Santé est un chef de file dans le domaine des télésoins, des dossiers de santé électroniques (DSE), des dossiers médicaux électroniques (DME), des dossiers de santé personnels (DSP), de la gestion de pharmacies et de la gestion des demandes de règlement en ligne. Nos solutions permettent aux autorités, aux fournisseurs de soins, aux médecins et aux patients d’obtenir de meilleurs résultats cliniques. Pour obtenir de plus amples renseignements au sujet de TELUS Santé, veuillez consulter le site telussante.com

Surgo est le seul fournisseur offrant la gamme complète de fournitures, d'équipement et d’impression médicaux au Canada. Nous offrons aux gestionnaires de clinique des services haut de gamme, dont les outils de gestion, ainsi que le système de commande de fournitures et de gestion de compte sans fil des plus rapides pour les grandes cliniques très achalandées et en croissance. Surgo offre un meilleur service grâce à des technologies de pointe qui permettent d’économiser du temps et de l’argent, des milles de récompense AIR MILES, et une garantie au plus bas prix.

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EXHIBITS | EXPOSITION The Canadian Association of Optometrists www.opto.ca

#325

The Canadian Association of Optometrists (CAO) is the national voice of optometry in Canada. Over 4,200 doctors of optometry and 400 optometry students comprise the membership of CAO, representing 85 per cent of doctors of optometry in Canada. The CAO works with its 10 provincial member associations within a federated framework.

L'Association canadienne des optométristes (ACO) est le porte-parole de l'optométrie à l'échelle nationale. Plus de 4 200 docteurs en optométrie (DO) et 400 étudiants en optométrie sont membres de l'ACO, représentant ainsi 85 % des DO au Canada. L'ACO collabore avec ses dix associations provinciales membres dans un cadre fédéré.

The Centre for Mindfulness Studies www.mindfulnessstudies.com

#M22

Contest Contribution: Gift certificate professional development course (MBCT) The Centre delivers clinically proven mindfulnessbased cognitive therapy to people living with mental health conditions and chronic illnesses such as anxiety and depression. Accessible and affordable, our therapeutic programs are led by specially trained physicians. A charitable social enterprise, we offer accredited facilitation training for health care professionals through the University of Toronto.

Le Centre fournit la thérapie cognitive basée sur la pleine conscience et prouvée en clinique aux personnes souffrants de troubles de santé mentale et de maladies chroniques, telles que l'anxiété et la dépression. Nos programmes thérapeutiques sont accessibles, abordables et dirigés par des médecins ayant reçu une formation spécialisée. Nous sommes une enterprise de bienfaisance sociale et offrons une formation de facilitation accréditée pour les professionels de la santé à l'Université de Toronto.

The Community Network www.cnetwork.tv

#114 Contest Contribution: iPad Mini

The Community Network operates digital information screens in hospitals and medical centres. These health information screens are an ideal way to promote the facilities and services of the host sites, highlight important health care issues, and educate the patients on health initiatives and community events.

Come and see us for more information on how to receive your free health screen!

Le Community Network installe des écrans d’information numérique dans les hôpitaux et les cliniques médicales. Ces écrans Santé sont un moyen idéal pour informer les patients sur les services proposés dans ces centres et dans leur communauté locale et s’avèrent un outil éducatif de valeur en matière de soins de santé. Passez nous voir et inscrivez-vous pour recevoir votre écran gratuit!

The Foundation for Medical Practice Education www.fmpe.org

#644

The Foundation for Medical Practice Education publishes 14 educational modules per year (7,000 members with 80+ topics in our library) to introduce family physicians to practice-based learning in order to maintain and enhance their professional knowledge and competence in addition to providing Mainpro-C accreditation with the CFPC. La Fondation de l’éducation pour la pratique médicale publie 14 modules éducatifs par année (7000 membres et plus de 80 sujets dans notre bibliothèque) pour offrir une méthodologie d’apprentissage fondé sur la pratique afin que les médecins de famille maintiennent et perfectionnent leurs connaissances et compétences professionnelles. Les programmes bénéficient de l’agrément Mainpro-C du CMFC.

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The Lung Association www.lung.ca/www.olapep.ca

#606

The Lung Association is dedicated to promoting and improving lung health for all Canadians. The Canadian Thoracic Society (CTS) is Canada’s national specialty society for respirology and the medical section of the Canadian Lung Association. The CTS promotes lung health through leadership, collaboration, research, education, and advocacy, and promoting the best respiratory practices in Canada.

L’Association pulmonaire se voue à la promotion et à l’amélioration de la santé pulmonaire de tous les Canadiens. La Société canadienne de thoracologie (SCT) est la société de spécialité nationale en pneumologie et la section médicale de l’Association pulmonaire du Canada. Elle promeut la santé pulmonaire en appuyant le milieu des soins respiratoires par le leadership, la collaboration, la recherche, la formation et le plaidoyer, et en favorisant des pratiques exemplaires dans ce domaine, au pays.

Thompson Region Division of Family Practice www.familypracticekamloopsarea.ca

#627

Contest Contribution: iPad The Thompson Region Division of Family Practice supports local family physicians and the delivery of primary care in Kamloops, BC, and the surrounding area. Through our attraction, retention, and practice transition services we are here to support passionate family physicians entering practice in the region! Visit www.familypracticekamloopsarea.ca for more information.

Thompson Region Division of Family Practice apporte du soutien aux médecins de famille de la région et la prestation de soins primaires à Kamloops (C.-B.) et les régions avoisinantes. Nous attirons et retenons les médecins de famille et fournissons des services de transition de la pratique afin de soutenir les médecins de famille passionés qui désirent exercer dans notre région! Visitez-nous à www.familypracticekamloopsarea.ca pour de plus amples renseignements.

Tilray www.tilray.ca

#432

When used responsibly, medical cannabis can be a safe, effective treatment for patients suffering from a variety of conditions. Tilray, a Health Canada– licensed producer, offers many cannabis strains, each with a different known effect and an exceptional level of quality.

Lorsqu’il est utilisé de façon responsable, le cannabis thérapeutique peut être un traitement sûr et efficace pour les patients atteints de différentes maladies.

Tilray, producteur autorisé par Santé Canada, offre plusieurs variétés de cannabis, chacune ayant un effet connu et un niveau de qualité exceptionnel.

Town of Smiths Falls www.smithsfalls.ca

#M10

Smiths Falls, Ontario (pop. 9,000). Located on the Rideau Canal, only one hour from Ottawa and Kingston, 350 km from Toronto, and 245 km from Montreal. Easy access to USA via international bridges at Johnstown and Ivy Lea. Newly approved area of high need—FHO position in new (2013) turnkey clinic. Contact cmacdonald@smithsfalls.ca Smiths Falls (Ontario) – population 9 000 habitants. Située sur le canal Rideau, à une heure seulement d'Ottawa et de Kingston, à 350 km de Toronto et à 245 km de Montréal. Les ponts internationaux Johnston et Ivy Lea offrent aux habitants de la région un accès facile aux États-Unis. Nouvellement approuvée comme une région à besoins élevés. Groupe de santé familiale (FSF) dans une nouvelle clinique clé en main depuis 2013. Communiquez avec nous à cmacdonald@smithsfalls.ca

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EXHIBITS | EXPOSITION Tourism Toronto www.SeeTorontoNow.com

#106

Toronto is one of the most cosmopolitan cities in the world; a place where international ideas intersect with Canadian culture. A centre of rare openness, warmth, energy and style, Toronto is enriched by the fusion of traditions, passions and perspectives on life of the more than 100 cultures found here.

Toronto est une des villes les plus cosmopolites au monde; un endroit où les idées internationales se mélangent à la culture canadienne. Un rare lieu qui dégage une ouverture, un accueil, une énergie et un style, Toronto est enrichie par la fusion des traditions, des passions et des façons de voir la vie de plus de 100 cultures.

Trimedic Supply Network www.trimedic-inc.com

#808

Trimedic Supply Network specializes in providing high-quality medical devices, supplies, and equipment for the health care professional. Our product line includes non-hormonal birth control options like the Flexi-T copper IUD and the Caya, one-size-fits-most, diaphragm. Premeno duo, a hormone-free, all-natural, vaginal ovule for dryness and the all-new Vagiwell Dilators are just some of our other products featured.

Trimedic Support Network fournit des dispositifs, des fournitures et de l'équipement médicaux de haute qualité aux professionnels de la santé.

Notre gamme de produits comprend des méthodes non hormomales de contraception comme le DIU Flexi-T en cuivre, le Caya à taille unique ajustable et des diaphragmes. Nous offrons, entre autres, le duo Premeno, ovule vaginal pour la sécheresse sans hormones et naturel, ainsi que les nouveaux dilatateurs Vagiwell.

Trudell Medical International www.trudellmed.com

#642

Trudell Medical International designs, develops, and manufactures a wide range of medical devices, from our flagship AEROCHAMBER* brand of Valved Holding Chamber for asthma patients and our latest state-of-the-art AEROBIKA* OPEP therapy system for COPD patients, to custom-designed products and systems. Efficacy of our best-in-class respiratory management products has been validated in over 500 peer-reviewed articles.

Trudell Medical International conçoit, développe et fabrique une large gamme de dispositifs médicaux, de notre marque vedette de chambres de retenue valvées AEROCHAMBER* destinée aux patients atteints de l’asthme et notre système de thérapie par PEPO de pointe AEROBIKA* pour les patients atteints de MPOC, jusqu’à nos produits et systèmes conçus sur mesure. Leur efficacité a été validée dans plus de 500 articles revus en comité de lecture.

Tyros Biopharma www.tyrosbiopharma.com

#632

A Canadian company based in Montreal, Quebec, Tyros Biopharma is a fully integrated, privately held pharmaceutical company that was founded in 2012.

We are devoted to providing health care professionals and patients with the highest-quality women’s health specialty products. Gynatrof™ is designed to relieve the symptoms of vaginal atrophy by enhancing the body’s natural moisture. It is a hormone-free gel, is fragrance free, contains HA and Vit. E, and is applied with a reusable applicator.

Fondée en 2012, Tyros Biopharma Inc est une société privée canadienne pleinement intégrée, basée à Montréal (Québec), qui exerce ses activités dans le domaine pharmaceutique. Nous avons pour mission d'offrir aux professionnels de la santé et à leurs patientes des produits spécialisés de qualité supérieure visant à améliorer la santé des femmes. Gynatrof™ soulage les symptômes de l'atrophie vaginale en stimulant l'hydratation naturelle du corps. Il s’agit d’un gel sans hormones et sans parfum qui contient de l'acide hyaluronique et de la vitamine E. Il s'applique avec un applicateur réutilisable.

UBC Family Medicine www.familymed.ubc.ca

#243

UBC Department of Family Medicine employs a distributed model of education involving, under one program, 16 educational sites, each providing its own distinctive strength and particular learning opportunities.

University of Alberta www.familymed.med.ualberta.ca

Contest Contribution: Cash The Department of Family Medicine at the University of Alberta offers a Residency Program and Additional Skills Programs. Our mandate is to graduate well-rounded, skillful physicians with a comprehensive knowledge base and interest in continuing medical education. The program has at their disposal a vast resource base in hospitals, clinics, and community service centres. Residents choose from a variety of programming choices and learning sites.

Le Département de médecine familiale de l’Université de l’Alberta offre un programme de résidence et des programmes de compétences avancées.

Notre mandat est de former des médecins possédant une base complète de connaissances et un intérêt pour la formation médicale continue. Le programme dispose d’une vaste base de ressources dans les hôpitaux, les cliniques et les centres de services communautaires. Les résidents ont un choix varié de programmes et de sites d’apprentissage.

University of Calgary www.ucalgary.ca/familymedicine

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#242 Contest Contribution: Cash

Join us to learn about the University of Calgary Family Medicine Programs. We are an energetic and innovative department. Our goal is to train outstanding family physicians. We offer excellent learning opportunities in a province that offers amazing lifestyle opportunities.

Venez nous visiter afin d'en apprendre davantage sur les programmes de médecine familiale offerts par l'Université de Calgary. Nous sommes un département novateur et dynamique. Notre but est de former des médecins de famille exceptionnels. Nous offrons d’excellentes occasions d’apprentissage dans une province qui offre également un superbe mode de vie.

University of Manitoba http://umanitoba.ca/faculties/health_sciences/ medicine/units/family_medicine/

#245

The University of Manitoba Family Medicine Residency Program offers many opportunities for residency training in urban, rural, bilingual, and northern/remote settings. We also offer an integrated Care of the Elderly option. Enhanced Skills Programs are available in areas such as Anesthesia, Emergency Medicine, Sports and Exercise Medicine, and Palliative Medicine.

Le programme de résidence en médecine familiale de l'Université de Manitoba offre de nombreuses occasions pour la formation en résidence dans les milieux ruraux, urbains, bilingues, nordiques ou éloignés. Nous offrons également le programme intégré de soins aux personnes âgées. Des programmes de compétences avancées vous sont offerts dans plusieurs domaines, tels que l'anesthésie, la médecine d'urgence, la médecine du sport et de l'exercice et les soins palliatifs.

University of Ottawa www.familymedicine.uottawa.ca

#347

The Department of Family Medicine at the University of Ottawa has five teaching sites in the Ottawa region and two rural teaching sites in Pembroke and Winchester. A francophone Ottawa community hospital site gives postgraduates and undergraduates an opportunity to learn in a French environment. Third-year opportunities in a wide range of disciplines of interest to family medicine are also available.

Le Département de médecine familiale de l’Université d’Ottawa compte cinq sites d’enseignement dans la région de la capitale nationale et deux dans les régions rurales de Pembroke et de Winchester. Un milieu de formation dans un hôpital communautaire francophone d’Ottawa donne la chance aux étudiants des niveaux postdoctoral et prédoctoral d’apprendre dans un environnement francophone. Des possibilités pour les étudiants de troisième année dans une grande variété de disciplines et d’intérêts en médecine familiale sont aussi offertes.

Le Département de médecine familiale de l’Université de la ColombieBritannique utilise un modèle d’éducation décentralisé impliquant, sous un même programme, 16 sites de formation offrant chacun des forces distinctives et des possibilités d’apprentissage particulières.

fmf.cfpc.ca

#346

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EXHIBITS | EXPOSITION University of Saskatchewan www.medicine.usask.ca/family

#447

The University of Saskatchewan’s Department of Family Medicine provides collaborative primary care sites for training family practice residents and other health professionals. It offers an academic and community-based program allowing residents to become family physicians with the skills to practise in rural, remote, and urban communities.

Le Département de médecine familiale de l’Université de la Saskatchewan compte des sites de soins primaires en collaboration pour la formation des résidents en médecine familiale et des autres professionnels de la santé. Il s’agit d’un programme universitaire basé dans la communauté qui permet aux résidents de devenir des médecins de famille compétents pour la pratique rurale, en région éloignée et dans les communautés urbaines.

University of Toronto www.dfcm.utoronto.ca

#342

The Department of Family and Community Medicine at the University of Toronto offers diversity and opportunities in all aspects of medical education.

Educational resources and professional development activities are highly developed at our 14 teaching sites and within a network of more than 40 community practices.

Le Département de médecine familiale et communautaire de l'Université de Toronto offre la diversité ainsi que des possibilités dans tous les aspects de l'éducation médicale. Des ressources pédagogiques et des activités de développement professionnel sont offertes dans nos 14 sites d’enseignements au sein d'un réseau de plus de 40 pratiques communautaires.

Valco Products www.valco.ca

#224

Health care professionals will have access to several necessary products in the treatment of venous and lymphatic diseases (MEDI compression garments, Circaid non-elastic compressive garments, Jovipak lymphedema garments, Huntleigh vascular and fetal dopplers, and sequential pumps by Huntleigh).

We shall also present a complete line of sport compression stocking by CEP and orthopedic bracing by MediOrtho. We look forward to meeting you at the booth!

Les professionnels de la santé auront accès à plusieurs produits indispensables pour le traitement des maladies veineuses et lymphatiques (vêtements compressifs Medi, Circaid et Jovipak, pompes séquentielles, dopplers fétaux et vasculaires par Huntleigh). Nous vous ferons aussi découvrir une gamme de bas compressifs sportifs par CEP ainsi que nos supports orthopédiques de Medi Ortho. Au plaisir de vous voir bientôt!

Voltaren Emulgel Extra Strength www.novartis.ca

#322

Novartis Consumer Health Canada, a GSK Consumer Healthcare Company, is one of the world's largest consumer health care companies. Our heritage spans over 160 years and many of our brands, including Voltaren Emulgel, are successful in over 100 countries because they all show our passion for quality, guaranteed by science.

Novartis Consumer Health Canada, entreprise GSK de soins de santé pour les consommateurs, est l’une des plus grandes sociétés de soins de santé pour les consommateurs au monde. Notre patrimoine s'étend sur plus de 160 ans et bon nombres de nos produits, tels que le Voltaren Emulgel, connaissent beaucoup de succèes dans plus de 100 pays, car ils sont preuve de notre passion pour la qualité et reposent sur la science.

Weeneebayko Health – Moose Factory www.waha.ca

#211

WAHA is responsible for providing comprehensive health services in the beautiful Weeneebayko region along the James Bay and Hudson Bay coastal regions in northern Ontario servicing six communities: Moose Factory, Fort Albany, Attawapiskat, Moosonee, Kashechewan, and Peawanuck. This very scenic and diverse area is rich in Aboriginal culture and history.

WAHA fournit des services de soins complets dans la magnifique région de Weeneebayko, située sur les rives des baies James et d'Hudson dans le nord de l'Ontario. Elle dessert six communautés : Moose Factory, Fort Albany, Attawapiskat, Moosenee, Kashechewan et Peawanuck. Découvrez la richesse et la diversité des cultures autochtones de cette région pittoresque.

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Welch Allyn www.welchallyn.ca

#636 Contest Contribution: Digital NIBP Device & Gyne Cordless Illumination System

Welch Allyn is a leading global manufacturer of medical diagnostic equipment and a complete range of digital and connected solutions that help reduce risk and enhance workflow in a variety of clinical settings. Welch Allyn specializes in helping frontline practitioners enhance care with innovative products, technologies, and solutions that improve patient outcomes, safety, and satisfaction.

Welch Allyn est un leader mondial de la fabrication d'équipement médical de diagnostic. Sa gamme complète de solutions numériques branchées aident à réduire le risque et à améliorer le flux des travaux dans divers contextes cliniques. Welch Allyn aide les praticiens de première ligne à améliorer leurs soins grâce à des solutions, des technologies et des produits novateurs qui améliorent les soins et la sécurité et augmentent la satisfaction de leurs patients.

Western University www.schulich.uwo.ca/familymedicine

#443

Contest Contribution: 2 books The Family Medicine residency program at Western trains comprehensive family physicians and leaders in family medicine through a curriculum that is supportive, flexible, and dedicated to the needs of its residents. Our family medicine program was the first in Canada to offer both a MClSc and PhD program in Family Medicine. Stop by our booth to meet our team and learn more about our programs!

Le programme de résidence en médecine familiale de l'Université Western forme des médecins de famille et des chefs de file en médecine familiale au moyen d'un programme souple, consacré aux besoins de ses résidents et qui favorise l’encadrement. Notre programme de médecine familiale a été le premier au Canada à offrir un MCISc et un doctorat en médecine familiale.

Venez rencontrer notre équipe afin d'en apprendre plus sur nos programmes!

Your Doctor Jobs www.ochrerecruitment.com

#M18

Contest Contribution: Doctor’s leather satchel With amazing locum and permanent opportunities in Australia, New Zealand, and now Canada, your next adventure could be just a heartbeat away with Your Doctor Jobs. Talk to us about making your next adventure a reality –let’s make it happen.

Avec nos extraordinaires possibilités de suppléance et de postes permanents en Australie, en Nouvelle-Zélande et maintenant au Canada, vous êtes peutêtre à deux doigts de voir votre prochaine aventure se réaliser grâce à Your Doctor Jobs. Venez nous en parler. Elle deviendra réalité.

YukonMD www.yukonmd.ca

#742 Contest Contribution: Cash

Discover the uniqueness Yukon has to offer a visiting or practising physician. From hiking, canoeing, fishing, to dog sledding, skiing, or seeing world-class performers at the arts centre … the list goes on. If you’re looking for an adventure, an experience of a lifetime —come join us at our YukonMD booth and see why practising in Yukon really is “Living the Dream.”

Découvrez le caractère unique du Yukon et ce qu’il peut offrir aux médecins en visitent ou qui s’installent dans ce territoire. Randonnée, canoë, pêche, traîneau à chiens, ski, des spectacles de classe mondiale à notre centre des arts, et j’en passe. Si vous cherchez l'aventure ou une expérience unique, visitez notre kiosque YukonMD pour découvrir pourquoi le Yukon est comme « un rêve devenu réalité ».

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mainpro-c courses / sÉANCES MAINPRO-C

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For more information on the CFPC Mobile APP, visit College Square in the Exhibit Hall Pour en apprendre davantage sur l’appli mobile du CMFC, visitez le Carrefour du Collège dans le Hall d’exposition

Important Notice

Avis important

The College of Family Physicians of Canada (CFPC) will arrange to have professional photography and video footage taken during the 2015 Family Medicine Forum (FMF). Please be advised that these materials may be published in CFPC materials in print and electronic format including the CFPC and FMF websites.

Le Collège des médecins de famille du Canada (CMFC) retiendra les services de photographes qui prendront des photos et des vidéos durant le Forum en médecine familiale 2015 (FMF). Veuillez noter que ces images pourraient être publiées sous formes imprimée et électronique dans le matériel du CMFC, y compris les sites web du Collège et du FMF.

By participating in the 2015 Family Medicine Forum, you 1) grant the CFPC the right and permission to use any such photographs/video clips in which you may be included, in whole or in part, for such purposes; 2) waive any right that you may have to inspect and/or approve any such photographs/video clips; 3) transfer to CFPC any right you may have in such photographs/ video clips and waive moral rights, if any; and 4) release and discharge CFPC from any liability that may arise from the use of such photographs/video clips by CFPC. All photographic materials become the property of the CFPC and may be displayed, distributed, or used by the CFPC for any purpose. Names and/or brief bios would be included with permission.

En participant au Forum en médecine familiale 2015, vous 1) accordez au CMFC les droits exclusifs d’utiliser, pour les fins susmentionnées, ces photographies/vidéos dans lesquelles vous pourriez apparaître, en tout ou en partie; 2) renoncez à tout droit que nous pourriez avoir d’inspecter ou d’approuver ces photos/ vidéos clips; 3) transférez au CMFC tous les droits que vous pourriez avoir sur ces photos/vidéos clips et renoncez à tous droits moraux, le cas échéant; et 4) dégagez le CMFC de toutes responsabilités pouvant découler de l’utilisation de ces photographies/vidéos clips par le CMFC. Tout le matériel photographique devient la propriété du CMFC et peut être affiché, distribué ou utilisé par le CMFC à n’importe quelle fin. Les noms et/ou une brève biographie seraient inclus avec votre autorisation seulement.

BAR CODE READERS

LECTEURS CODE-BARRE

IMPORTANT! All FMF registrants must have their name badge scanned each day they attend the conference. CFPC staff will be happy to scan your badge for you or you may use the convenient self-scan stations located throughout the conference venues.

IMPORTANT ! Tous les participants inscrits au FMF doivent faire scanner leur insigne d’identité les jours où ils assistent à la conférence. Le personnel du CMFC sera en mesure de scanner votre insigne ou encore vous pouvez utiliser les postes de lecteur codebarre situés à des endroits pratiques sur les lieux de la conférence.

Registration: All registrants at FMF 2015 will have their name badge scanned as proof of attendance.

Exhibit Hall: Many exhibitors will have bar code readers available at their booths. With your permission, booth staff will scan the bar code on your badge to obtain the information as it appears on your FMF 2015 registration.

Inscription : Tous les participants au FMF 2015 doivent faire scanner leur insigne d’identité comme preuve de leur présence.

Hall d’exposition : Nombre d’exposants disposeront d’un lecteur code-barre à leur kiosque. Avec votre permission, ils pourront scanner votre insigne d’identité pour obtenir l’information telle qu’elle apparaît sur votre inscription au FMF 2015.

Printed on Rolland Enviro100 Satin, 60 lb Text, which contains 100% post-consumer fiber, is FSL®, EcoLogo and Processed Chlorine-Free certified and is manufactured using renewable biogas energy.

Imprimé sur du papier d’impression Rolland Enviro100 Satin 60 lb texte. Ces papiers sont faits de fibres 100 % post-consommation, certifiées FSC® et EcoLogo. Procédé sans chlore et fabriqué à partir d’énergie renouvelable biogaz.

Environmental savings per ton (compared to its virgin equivalent):

Économies environnementales par tonne (par rapport à la matière vierge équivalente) :

trees 24

water 86,910 litres

air emissions 1,065 kg CO2

solid waste 3,495 kg

This program is provided for information purposes only. The College of Family Physicians of Canada (CFPC) reserves the right to delete, alter, or otherwise amend any aspect of the program as deemed appropriate. The CFPC reserves the right to cancel sessions due to unforeseen circumstances. The CFPC cannot accept responsibility for out-of-pocket expenses due to the cancellation of a session. The Scientific Program Planning Committee endeavours, where possible, to schedule clinical sessions in the same track/theme in unopposing time slots unless prohibited by presenter and/or room availability.

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arbres eau émissions atmosphériques déchets solides 24 86 910 litres 1 065 kg CO2 3 495 kg

Ce programme est fourni uniquement à titre d’information. Le Collège des médecins de famille du Canada (CMFC) se réserve le droit de supprimer, de modifier ou de réviser tout aspect du programme s’il le juge opportun. Le CMFC se réserve le droit d’annuler les séances en raison de circonstances imprévues. Le CMFC n’accepte aucune responsabilité concernant les dépenses personnelles à la suite de l’annulation d’une séance. Le Comité de planification du programme scientifique s’efforce, dans la mesure du possible, de présenter les séances cliniques de même nature/thème dans des cases horaires différentes, à moins de contraintes liées à la disponibilité du présentateur et/ou de la salle.

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Strategic Partners / Partenaires stratĂŠgiques Platinum / Platine

Continuing Partners / Fidèles partenaires Platinum / Platine

Gold / Or

Annual Partners / Partenaires annuelles Diamond / Diamant

Sapphire / Saphir

save the date • dates à retenir CONNECT ÉCHANGER

LEARN APPRENDRE

GROW GRANDIR

VANCOUVER

november 9–12 novembre

2016

Vancouver Convention Centre Palais de congrès de Vancouver

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